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FACTORS THAT INFLUENCE
CHILDREN’S BOOSTER SEAT USE
by
Judith Charlton
Sjaanie Koppel
Michael Fitzharris
Melinda Congiu
Brian Fildes
April 2006
Report No. 250
ii
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
REPORT DOCUMENTATION PAGE
Report No.
250
Title and sub-title:
Date
April 2006
ISBN
0 7326 2320 0
Pages
93
Factors that Influence Children’s Booster Seat Use
Author(s):
Judith Charlton, Sjaanie Koppel, Michael Fitzharris, Melinda Congiu & Brian Fildes
Sponsoring Organisation(s):
Motor Accidents Authority
_____________________________________________________________________________
Abstract:
The aim of this study was to gain a more detailed understanding of the restraint usage rates,
‘appropriateness’ of restraint use, and the factors that influence appropriate restraint use for
children in the booster seat age group. Six hundred and ninety nine parents from the States of New
South Wales and Victoria completed a questionnaire regarding restraint use by their children aged
4 to 11 years. The findings revealed that only 24 percent of children aged between 4 and 11 years
old were travelling in a booster seat, while the remaining 76 percent were travelling in a seat belt.
Children travelling in booster seats were significantly younger (5.8 years vs. 8.2 years), lighter in
weight (21.9 kg vs. 30.3 kg) and shorter in height (115 cm vs. 131 cm) compared with children
travelling in a seat belt. Children travelling in a booster seat were also significantly more likely to
be sitting in the front passenger position (for all vehicle types) (38%) compared to children
travelling in a seat belt (28%). Appropriateness of restraint use was computed using height criteria
of 100-140 cm for booster seats and greater than 140 cm for seat belts. Based on the height
measurements provided by parents, children travelling in booster seats were found to be
significantly more likely to be appropriately restrained (93%) compared to children travelling in a
seat belt (25%). The likelihood of being appropriately restrained in a booster seat was greater for
female children compared with males and greater amongst those who had a sibling in a seat belt
compared with those who did not. Appropriate booster use was also influenced by parents’
knowledge about size thresholds for transition to seat belts and there was a greater likelihood of
appropriate use of boosters with increasing age and weight of the child. Amongst those children
using a seat belt, the mean age for their transition into a seat belt was 5.6 years. The most important
reason cited by parents for moving a child into a seat belt was that the child was too big for their
forward facing child restraint/booster seat (69%). Children who were appropriately restrained in a
seat belt were more likely to be in a smaller vehicle than a larger vehicle and not have another
sibling in a booster seat compared to those who did have a sibling in a booster seat. Additionally,
the likelihood of appropriate seat belt use increased with greater weekly distance travelled and
increased age and weight of the child. The findings highlighted the need to improve legislation on
child restraint usage and to promote awareness amongst both parents and children of safety benefits
associated with appropriate restraint use and seating position.
Key Words:
Child safety, Booster seats, Child Seats, Child Restraints, Safety, Countermeasure
Reproduction of this page is authorised
Monash University Accident Research Centre,
Building 70, Wellington Road, Clayton, Victoria, 3800, Australia.
Telephone: +61 3 9905 4371, Fax: +61 3 9905 4363
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
iii
Preface
Project Manager
Dr. Judith Charlton, Senior Research Fellow
Research Team
Dr. Sjaanie Koppel, Research Fellow
Mr Michael Fitzharris, Research Fellow
Ms Melinda Congiu, Research Assistant
Ms Kristen Moore, Research Assistant
Ms Joanne Tziotis, Research Assistant
Mr Jim Scully, Research Assistant
Prof. Brian Fildes, Chair of Road Safety
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MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
Acknowledgements
The research team wishes to thank the Motor Accidents Authority for the Research Grant
for this research. We also thank a number of organisations and individuals for their
assistance with various aspects of the research. In particular, we would like to thank the
NSW Department of Education and Training and the Department of Education and
Training Victoria for their support and the many Primary School Principals who assisted us
with distribution of the questionnaire to parents. Our sincere thanks go to the parents of
school children who volunteered to participate in this research. We wish to thank Rebecca
Markiewicz at Direct Response for prompt and accurate data entry, Jim Scully for his
assistance with the ABS data, Joanne Tzisotis for her assistance with the collection of
safety educational materials for parents and children, and Kristen Moore for her assistance
with recruitment.
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
v
Contents
EXECUTIVE SUMMARY....................................................................................................IX
1
INTRODUCTION............................................................................................................ 1
1.1
CHILD INJURIES AND CRASH RISK ................................................................................ 1
1.1.1
Child Restraint Systems (CRSs) ......................................................................... 3
1.1.2
Legislation pertaining to CRS use...................................................................... 4
1.1.3
Educational resources available........................................................................ 5
1.1.4
CRS Use and Misuse .......................................................................................... 8
1.1.5
Factors that influence booster seat use............................................................ 11
1.1.6
Summary and Aims of the Current Study ......................................................... 12
2
SURVEY OF THE FACTORS THAT INFLUENCE ‘APPROPRIATE’
RESTRAINT USE IN THE BOOSTER SEAT AGE GROUP .......................................... 13
2.1
METHOD .................................................................................................................... 13
2.1.1
Participants and Recruitment........................................................................... 13
2.1.1.1 Recruitment in New South Wales ................................................................ 13
2.1.1.2 Recruitment in Victoria................................................................................ 15
2.1.2
Questionnaire ................................................................................................... 16
2.1.3
Procedure ......................................................................................................... 17
2.1.4
Analyses............................................................................................................ 17
3
RESULTS........................................................................................................................ 18
3.1
RECRUITMENT RATES ............................................................................................... 18
3.2
SECTION A: DEMOGRAPHIC AND DRIVING INFORMATION ......................................... 18
3.2.1
Demographic Information................................................................................ 18
3.2.2
Restraint Use .................................................................................................... 25
3.2.3
Motor Vehicle Crashes..................................................................................... 29
3.3
SECTION B: CHILDREN’S USE OF BOOSTER SEATS .................................................... 29
3.3.1
Factors associated with the Appropriate Use of Booster Seats ....................... 37
3.4
SECTION C: CHILDREN’S USE OF SEAT BELTS ........................................................... 39
3.4.1
Factors associated with the Appropriate Use of Seat Belts ............................. 42
4
SUMMARY AND DISCUSSION ................................................................................. 44
4.1
INFORMATION ABOUT PARENTS WHO COMPLETED THE QUESTIONNAIRE .................. 44
4.2
RESTRAINT USAGE RATES, PATTERNS OF RESTRAINT USAGE AND
‘APPROPRIATENESS’ OF RESTRAINT USE ................................................................................ 45
4.2.1
Children’s Use of Booster Seats....................................................................... 47
4.2.1.1 Factors associated with the Appropriate Use of Booster Seats.................... 48
4.2.2
Children’s Use of Seat Belts............................................................................. 49
4.2.2.1 Factors associated with the appropriate use of seat belts ............................. 50
4.3
LIMITATIONS ............................................................................................................. 50
5
CONCLUSIONS AND RECOMMENDATIONS ....................................................... 51
5.1
CONCLUSIONS ........................................................................................................... 51
5.1.1
Recommendations for promoting booster seat use .......................................... 52
5.1.2
Recommendations for further research............................................................ 53
6
REFERENCES ............................................................................................................... 54
7
APPENDICES ................................................................................................................ 58
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MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
Figures
FIGURE 1 NUMBER OF FATALITIES AND INJURIES ADJUSTED PER 100 000 POPULATION FOR
CHILDREN 10 YEARS AND YOUNGER BY AGE GROUP FOR THE STATE OF NEW SOUTH
WALES IN THE SIX-YEAR PERIOD FROM 2000 TO 2005 (RTA, 2006; ABS, 2006). .............. 2
FIGURE 2 PERCENTAGES OF CHILD FATALITIES AND INJURIES IN CHILDREN 10 YEARS AND
YOUNGER BY AGE GROUP AND RESTRAINT WEARING STATUS IN 2005 FOR THE STATE OF
NEW SOUTH WALES (RTA, 2006)....................................................................................... 3
FIGURE 3 SCHOOL REGIONS IN NEW SOUTH WALES ................................................................. 14
FIGURE 4 SCHOOL REGIONS IN VICTORIA ................................................................................. 16
FIGURE 5 AGE GROUPS (YEARS) OF PARTICIPANTS WHO COMPLETED THE QUESTIONNAIRE ...... 19
FIGURE 6 MARITAL STATUS OF PARTICIPANTS WHO COMPLETED THE QUESTIONNAIRE ............ 19
FIGURE 7 PLACE OF RESIDENCE FOR PARTICIPANTS WHO COMPLETED THE QUESTIONNAIRE .... 20
FIGURE 8 ANNUAL HOUSEHOLD INCOME FOR PARTICIPANTS WHO COMPLETED THE
QUESTIONNAIRE ................................................................................................................. 20
FIGURE 9 HIGHEST LEVEL OF EDUCATION REACHED FOR PARTICIPANTS WHO COMPLETED
THE QUESTIONNAIRE .......................................................................................................... 21
FIGURE 10 TYPE OF VEHICLE TYPICALLY DRIVEN BY PARTICIPANTS WHEN TRAVELLING WITH
THEIR CHILDREN ................................................................................................................ 23
FIGURE 11 KILOMETRES DRIVEN WITH CHILDREN PER WEEK FOR PARTICIPANTS WHO
COMPLETED THE QUESTIONNAIRE ...................................................................................... 23
FIGURE 12 AVERAGE TRIP LENGTH DRIVEN WITH CHILDREN FOR PARTICIPANTS WHO
COMPLETED THE QUESTIONNAIRE ...................................................................................... 24
FIGURE 13 FREQUENCY OF DRIVING WITH CHILDREN FOR PARTICIPANTS WHO COMPLETED
THE QUESTIONNAIRE .......................................................................................................... 24
FIGURE 14 PERSON WHO DOES MOST OF THE DRIVING WITH CHILDREN FOR PARTICIPANTS
WHO COMPLETED THE QUESTIONNAIRE.............................................................................. 25
FIGURE 15 PROPORTION OF BOOSTER SEAT AGED CHILDREN ‘APPROPRIATELY’ RESTRAINED
BY AGE .............................................................................................................................. 27
FIGURE 16 FREQUENCY OF BOOSTER SEAT USE ........................................................................ 30
FIGURE 17 CIRCUMSTANCES UNDER WHICH CHILDREN WERE ALLOWED TO TRAVEL IN A
VEHICLE WITHOUT A BOOSTER SEAT .................................................................................. 30
FIGURE 18 PARENTS’ ACQUISITION OF A BOOSTER SEAT FOR THEIR CHILD ............................... 31
FIGURE 19 FACTORS THAT WERE PRIORITIES (HIGH/MEDIUM/LOW) IN THE BOOSTER SEAT
PURCHASE PROCESS ........................................................................................................... 33
FIGURE 20 FACTORS RANKED AS THE HIGHEST PRIORITY IN THE BOOSTER SEAT PURCHASE
PROCESS ............................................................................................................................ 34
FIGURE 21 AGE DISTRIBUTION FOR CHILDREN MOVING INTO SEAT BELTS. ............................... 40
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
vii
Tables
TABLE 1 SUMMARY OF AUSTRALIAN LITERATURE ON CHILD RESTRAINT RECOMMENDATIONS ... 6
TABLE 2 NEW SOUTH WALES PUBLIC (PRIMARY) SCHOOLS THAT AGREED TO PARTICIPATE .... 15
TABLE 3 VICTORIAN PRIMARY SCHOOLS THAT AGREED TO PARTICIPATE ................................. 16
TABLE 4 REPRESENTATIVENESS OF THE DEMOGRAPHIC CHARACTERISTICS FOR
PARTICIPANTS.................................................................................................................... 22
TABLE 5 CHILDREN’S AGE, WEIGHT, HEIGHT AND SEATING POSITION BY RESTRAINT TYPE .. 26
TABLE 6 REASONS THAT CHILDREN’S TYPICAL SEATING POSITIONS DIFFERED ......................... 28
TABLE 7 INFORMATION SOURCES USED WHEN PURCHASING THE BOOSTER SEAT ...................... 32
TABLE 8 MOST USEFUL INFORMATION SOURCE USED WHEN PURCHASING THE BOOSTER SEAT. 32
TABLE 9 PARENTS’ REASONS FOR MOVING THEIR CHILD INTO A BOOSTER SEAT ...................... 35
TABLE 10 MOST IMPORTANT REASON FOR MOVING THEIR CHILD INTO A BOOSTER SEAT ......... 36
TABLE 11 ODDS RATIOS (95TH %CI) FOR KEY PARAMETERS ASSOCIATED WITH FACTORS
THAT INFLUENCE THE APPROPRIATE USE OF A BOOSTER SEAT ........................................... 38
TABLE 12 PARENTS’ REASONS FOR MOVING THEIR CHILD INTO A SEAT BELT ........................... 41
TABLE 13 THE MOST IMPORTANT REASON FOR MOVING THEIR CHILD INTO A SEAT BELT ......... 42
viii
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
EXECUTIVE SUMMARY
Introduction
Motor vehicle crashes are one of the leading causes of child death and acquired disability.
Australian legislation requires the use of a child restraint for infants up to one year old;
however for older children the legislation is less definitive, stating that only an
‘appropriate’ restraint should be used. In the absence of more clear guidelines for child
restraint system (CRS) use, the responsibility largely rests upon parents to determine what
restraint is appropriate for their child. Previous research has shown that older children are
commonly ‘graduated’ to seat belts too early. That is, children who grow out of a child
restraint suitable for young children move directly into a seat belt, rather than moving into
a booster seat. This premature graduation places children at a greatly increased risk of
significant injuries in the event of a motor vehicle crash.
However, booster seat usage rates and the underlying explanations for inappropriate use of
restraints (i.e., seat belts) are not well researched in Australia. While the call for better
legislation and public awareness has gathered momentum internationally, Australia appears
to be lagging behind Europe and the United States in terms of addressing the issue of
appropriate restraint use for older children.
Survey of parents’ attitudes about child restraint use
The broad aim of this study was to gain a more detailed understanding of restraint usage
rates, patterns of restraint usage and ‘appropriateness’ of restraint use by children in the
‘booster seat age’. Another aim of the study was to determine the factors that influence
appropriate restraint use for children in the booster seat age group.
Six hundred and ninety nine parents (response rate = 17%) from the States of New South
Wales and Victoria completed a questionnaire regarding restraint use by their children
aged 4 to 11 years. The questionnaire asked parents about their restraint use, their
children’s restraint use, their travel patterns, their motor vehicle crash history, as well as a
range of demographic questions.
Results
Demographic and driving information for parents of booster seat aged children
Most participants who completed the questionnaire were female (88%), aged between 31 to
45 years (82%), married (78%), living in a metropolitan area (36%), living in NSW (70%),
earning between $41,000 and $75,000 per year (33%) and had finished a degree or
technical school/TAFE course (52%).
In terms of their driving information, most participants reported that they usually drive
their children in a four door sedan (44%). Participants also reported that they typically
drove less than 100 kilometres per week with their children (61%), that most of their trips
were between five and ten kilometres (53%), that they drove their children daily or almost
daily (81%) and that they were the person that drove their children the most (88%). Only a
small proportion of participants reported that they had been in a motor vehicle crash in the
last two years (5%).
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
ix
Restraint usage rates, patterns of restraint usage and ‘appropriateness’ of restraint
use
Almost all parents (99%) indicated they were ‘always’ restrained while travelling in their
vehicle. Similarly, almost all parents indicated that their booster seat aged child/children
was/were ‘always’ restrained (98%).
When asked to indicate the type of restraint that their children travelled in, only 24 percent
of children aged between 4 to 11 years were travelling in a booster seat, while the
remaining 76 percent were travelling in a seat belt. Not surprisingly, children travelling in
booster seats were significantly younger, lighter (in terms of their weight) and shorter (in
terms of their height) than children travelling in a seat belt. However what was surprising
was that children travelling in a booster seat were significantly more likely to be sitting in
the front passenger position (for all vehicle types) (38%) compared to children travelling in
a seat belt (28%).
An important aim of this study was to determine if children aged between 4 and 11 years
were appropriately restrained while travelling in their vehicle. While there is no current
Australian legislation regarding the appropriateness of restraints for older children, there
are some Australian-based guidelines and international recommendations and legislation
indicating appropriateness of restraint use based on approximate age, weight and/or height
measures. While there are some small variations in these guidelines, for the purpose of the
current study, the criterion selected was a relatively conservative measure: Children were
appropriately restrained in a booster seat if their height was more than 100 centimetres and
less than or equal to 140 centimetres, while children travelling in a seat belt were
appropriately restrained if their height was more than 140 centimetres (i.e., NHTSA, 2001).
The children’s height, rather than their age or weight, was used to assess appropriateness
because their height governs the positioning of the lap/shoulder seat belt across the child’s
shoulder and hips. Based on the height measurements provided by parents, children
travelling in a booster seat were significantly more likely to be appropriately restrained
(93%) compared to children travelling in a seat belt (25%). That is, according to the current
guidelines, 75 percent of children in the current sample are too short to be properly
restrained by their seat belt.
When seating position (front vs. rear) was taken into account, the proportion of children
travelling appropriately in a booster seat decreased from 93 percent to 51 percent.
Similarly, the proportion of children travelling appropriately in a seat belt decreased from
25 percent to 15 percent. Rear seat occupancy is generally encouraged in Australia and
there is a growing body of evidence supporting its safety benefit over front seat passenger
occupancy.
Children’s use of booster seats
Booster seat use was examined using the responses from 243 parents with a child aged 4 to
11 years, who was currently restrained using a booster seat. When asked to indicate what
factors were important in purchasing a booster seat, most parents stated that it was ensuring
that the booster seat met with the Australian standards (94%) and that it was comfortable
for their child (84%). Parents were also asked why they moved their child into a booster
seat, and most parents indicated that the most important reason for moving their child into
a booster seat was that their child was too big for a forward facing child restraint (72%).
Furthermore, parents were asked to indicate how they would know when to move their
child into a seat belt. Most parents indicated that they would move their child into a seat
x
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
belt when their child reached the upper end of the weight range recommended by the child
seat manufacturer (75%).
Factors associated with the appropriate use of booster seats
Regression modelling was used to identify key factors associated with the appropriate
booster seat use. There was an increased likelihood of children using booster seats
appropriately with increasing age and weight of the child. Additionally, the likelihood of
being appropriately restrained in a booster seat was greater for female children compared with
males and greater amongst those who had a sibling in a seat belt compared with those who did not.
Appropriate booster use was also influenced by parents’ knowledge about size thresholds
for transition to seat belts.
Children’s use of seat belts
Children’s use of seat belts was examined using the responses from 514 parents with a
child aged 4 to 11 years, who were currently restrained in a seat belt. When asked to
indicate what restraint their child had been in before moving into a seat belt, most parents
indicated that their child had been restrained by a booster seat before moving into a seat
belt (88%). The mean age for children moving into a seat belt was 5.6 years. Parent were
asked to indicate the most important reason for moving their child into a seat belt, with the
majority of parents indicating that they had moved their child because their child was too
big for the forward facing child restraint/booster seat (69%).
Factors associated with the appropriate use of seat belts
A series of univariate analyses were conducted to determine the factors associated with
appropriate use of seat belts. Children who were appropriately restrained in a seat belt were
more likely to be in a smaller vehicle than a larger vehicle and not have another sibling in a
booster seat compared to children who did have a sibling in a booster seat. Additionally,
the likelihood of appropriate seat belt use increased with increased weekly distance
travelled and increased age and weight of the child.
Conclusion and Recommendations
The results of this study showed that only 24 percent of children in the ‘booster seat age
group’ (i.e. 4 to 11 years) were travelling in a booster seat. The findings from this study
also showed that children travelling in a booster seat were significantly more likely to be
appropriately restrained compared to children in a seat belt. Given the potential for either a
volunteer or reporting bias, these results may even be an over-estimate of the appropriate
usage of restraints.
Based on the findings of this study, it is recommended that educational and awareness
materials and programs be developed for parents and children providing information on the
safety benefits associated with CRS use; injury risk associated with premature graduation
into seat belts; appropriate transition from forward facing child restraint to booster seats
and booster seats to seat belts; safety benefits associated with rear seat positioning; and tips
for parents to encourage their children to remain restrained in the appropriate restraint type.
This study has provided a rich source of information regarding restraint usage rates,
patterns of restraint use, and ‘appropriateness’ of restraint use amongst children aged 4 to
11 years, as well as the factors that influence parents’ decisions about their child’s restraint
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
xi
use. Future research should attempt to examine the influence of children’s attitudes
towards restraint use.
xii
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
FACTORS THAT INFLUENCE CHILDREN’S
BOOSTER SEAT USE
1 INTRODUCTION
Motor vehicle crashes are one of the leading causes of child death and acquired disability
(NHTSA, 2002). Australian legislation specifies the use of a dedicated child restraint
system (CRS) for infants up to one year old; however, for older children, the legislation is
less definitive, stating only that an ‘appropriate’ restraint (dedicated child restraint or seat
belt) should be used. Hence, the responsibility largely rests upon parents to determine what
restraint is ‘appropriate’ for older children. The most difficult decisions are likely to be for
the transitions from forward facing child restraints to booster seats and seat belts. The
current study aimed to investigate restraint usage rates, patterns of restraint usage and
‘appropriateness’ of restraint use by children in the ‘booster seat age group’, as well as the
attitudes of parents of children in the booster seat age group towards restraint wearing
behaviour.
In order to investigate the ‘appropriateness’ of restraint use, as well as Australian parental
attitudes and behaviours in relation to their child’s restraint use, a self-administered
questionnaire was sent to parents of booster seat aged children (i.e., 4-11 years) in New
South Wales and Victoria. More specifically, the questionnaire asked parents to identify
usage rates and patterns of restraint use by their children in the booster seat age group, as
well as the factors that influenced their transition into a booster seat and/or into a seat belt.
This report briefly outlines the issues surrounding child occupant safety and particularly
child restraint use for children in the booster seat age group. In this section of the report,
the previous literature on child occupant crash rates is presented and a discussion of the
factors that are likely to affect parental attitudes to child restraint use is provided. Section 2
describes the study method including the development of the questionnaire. In Sections 3
and 4, the results of the questionnaire are presented and discussed. Section 5 summarises
the findings of the study and provides practical recommendations and areas for further
research and development are considered.
1.1
CHILD INJURIES AND CRASH RISK
In Australia, for the 12 month period ending December 2005, 72 children aged 16 years
and younger were killed as motor vehicle passengers (ATSB, 2006). On average, an
additional 850 children are seriously injured annually on Australian roads (annual average
for the four-year period 2000–2003; ATSB, 2004). In the State of New South Wales,
approximately 10 children aged 10 years and younger are killed annually and 690 children
are injured as car passengers (annual average for the six-year period 2000-2005; RTA,
2006). Figure 1 shows the number of child car occupant injuries and fatalities in NSW per
100,000 population by age groups. These data represent average annual figures for the sixyear period from 2000 to 2005.
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
1
Number of fatalities and injuries per
100,000 population
500
450
400
350
300
250
200
150
100
50
0
<1
1-4
5-10
Age (years)
Figure 1 Number of fatalities and injuries adjusted per 100 000 population for children 10
years and younger by age group for the State of New South Wales in the six-year period
from 2000 to 2005 (RTA, 2006; ABS, 2006).
When the data in Figure 1 is represented as percentages, it shows that 60.7 percent of all
fatalities and injuries in children 10 years and younger during the period 2000 to 2005
occurred in children aged between 5 and 10 years, 32.5 percent occurred in 1-4 year olds
and the remaining 6.8 percent were aged one year or younger. These data suggest that
children aged 5 to 10 years or those in the ‘booster seat age group’ are over-represented in
serious casualty and fatality motor vehicle crashes. While the data in Figure 1 has been
adjusted per 100,000 population, it should be noted that data has not been corrected for
travel exposure due to the fact that relevant child passenger data are not readily available.
Figure 2 shows the proportions of injuries and fatalities in children 10 years and younger
by age group and restraint wearing status. For children aged less than 1 year who were
killed or injured, just over 40 percent were restrained in a child restraint, around 16 percent
were restrained by seat belts, around 10 percent were not belted and for approximately 30
percent of cases restraint type was unknown. A different pattern is evident for the 1-4 year
age group: Around 40 percent in seat belts, 20 percent in child seats and for the remainder
the restraint status was not known. For the 5-10 year olds, the same pattern is evident as the
1-4 year olds, but the effect is magnified: Around 84 percent of all injured children in this
age group were restrained by seat belts and for the remainder of cases, restraint use was
unknown.
2
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
Percentage
100
<1 yr
80
1-4yrs
60
5-10yrs
40
20
0
Belt Belt Not Unknown
Child
Adult
Fitted Fitted
Restraint Belt
Worn Not Worn
Type of Restraint Used
Figure 2 Percentages of child fatalities and injuries in children 10 years and younger by
age group and restraint wearing status in 2005 for the State of New South Wales (RTA,
2006)
While these injury figures are of concern, it is important to consider them in the context of
all crashes involving child occupants, including those in which no injuries were sustained.
For example, previous research conducted in the mid-90s suggests that deaths and serious
injuries represent a relatively small percentage of all restrained child occupants involved in
crashes (approximately 12% of all cases sustained injuries greater than MAIS+2)
(Henderson, 1994). These findings suggest that overall, Australian child restraint systems
provide a good level of protection for young vehicle occupants.
1.1.1
Child Restraint Systems (CRSs)
There are four main types of CRSs, suitable for children of different sizes: infant capsules,
convertible seats (converts from a rear-facing seat for infants to a forward-facing seat),
dedicated forward facing child restraint and booster seats. Each of the CRS types are
outlined briefly below.
•
Infant capsules are designed for children from birth to approximately 6 months of
age (or less than 9 kg and/or less than 70 cm). Infant capsules are typically onepiece, protective moulded shells. They are designed for rear-facing installation
only. The capsule is designed so that in the event of a crash, impact forces will be
evenly spread over the infant’s back, with minimal jarring to the vulnerable head
and neck area.
•
Convertible seats incorporate features to allow use by infants as well as toddlers. In
the rearward-facing position, the convertible seat is used from birth until
approximately 6 months of age (or less than 9 kg and/or less than 70 cm). As with
the infant capsule, the purpose of the harness system in the rearward-facing
convertible seat is designed so that in the event of a crash, impact forces will be
evenly spread over the infant’s back, with minimal jarring to the vulnerable head
and neck area. In the forward-facing position, the convertible seat carries the child
from approximately 6 months to 4 years (or between 8 to 18 kg and/or 70 to 100
cm). This seating position is used when the child is able to sit and easily hold his or
her head upright.
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
3
•
Forward-facing seats are used to carry children from approximately 6 months to 4
years (or between 8 to 18 kg and/or 70 to 100 cm). Like the convertible CRS used
in the forward-facing mode, dedicated forward-facing child seats should also be
used only when the child is able to sit and easily hold his or her head upright. The
restraint uses a five-point harness. For these seats, the height of the shoulder strap is
usually above the child’s shoulders to effectively limit head excursion and the
height of the seat back should be above the child’s ear in order to provide adequate
head protection in the event of a crash.
•
Booster seats are designed for children approximately aged between 4 and 10 years
(or for children between the heights of 100 and 140 cm). Booster seats are used
when the child has outgrown a forward-facing child seat but when they are still too
small for a seat belt. The booster seat ensures that the lap/shoulder seat belt is
positioned correctly across the child’s shoulder and hips. It also raises the child so
that they can see out of the window and so their knees bend comfortably. There are
two types of booster seats: belt-positioning (‘booster cushion’) and high-back beltpositioning (‘booster seat’). In assessing the range of children who would benefit
from booster seats, height is a better indicator than age or weight because it governs
the positioning of the lap/shoulder seat belt across the child’s shoulder and hips
(NHTSA, 2001).
Recent estimates of CRS effectiveness have suggested that overall, CRS may reduce injury
by approximately 70 percent compared with unrestrained children (Mackay, 2001; Webber,
2000). For example, in an in-depth study of Australian fatal crashes involving child
occupants, Henderson (1994) reported a 26 percent reduction in MAIS2+ injuries for those
restrained in a CRS over a two- or three-point seat belt. In the US, Durbin (2001) found a
60 percent reduction in risk of injury overall for those restrained in a child seat over those
in seat belts restraints, and a 70 percent reduction in risk of a head injury.
1.1.2
Legislation pertaining to CRS use
Australian legislation pertaining to CRS use requires that children less than one year must
be restrained in an approved CRS that is properly fitted and adjusted. However, the law
relating to use of child restraints by older children is less definitive and states that children
over one year must be in either an appropriate child restraint or must use a suitable seat belt
(National Transport Commission, 2000). In the absence of more clear guidelines for CRS
use, the responsibility largely rests upon parents to determine what restraint is ‘appropriate’
for their child.
Internationally, there has been a great deal of emphasis on improving legislation relating to
booster seat use and nationwide awareness campaigns have promoted the use of child
restraints for older children (see National SafeKids Campaign, http://www.safekids.org/).
For example, in the United States, legislation in California was changed in 2002 to specify
that children must be secured in an appropriate child passenger restraint (safety seat or
booster seat) until they are at least 6 years old or weigh at least 60 pounds (27 kg). The
current legislation in Washington requires that children aged 4-6 years, or weighing 20-40
pounds (or 9.09-18.18 kg), must be in a booster seat. However, more comprehensive
legislation is due to come into effect on June 1st 2007, which will require children up to the
age of 8 years, or 4 foot 9 inches tall (145 cm) to be transported in a child restraint system
(eg. a child car seat or booster seat). One shortfall of both the current and upcoming
Washington legislation is that vehicles that are equipped with lap-only seat belts are
exempt from the requirement to use a booster seat.
4
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
In Europe, a recent directive to take effect by 2006 has called for the use of boosters by
children up to the age of 11 years and 153 cm tall. The UK legislation regarding child
restraints will change in May 2006 in line with this directive, however it will only require
that children aged 3 years or older and up to 135 cm (not 153 cm) in height will be required
to wear an appropriate child restraint. It is interesting to note that there is some variability
across the different countries in terms of the recommended height requirements for moving
a child into a seat belt (between 135-153cm).
In 2004, Winston et al. (2004) demonstrated the dramatic effect of legislation on child
restraint wearing rates in the United States. More specifically, the authors investigated
restraint types used by US children under the age of 9 years between 1998 and 2002
following a series of outreach activities to promote restraint use for children over the age of
four years. Between 1998 and 2002, the authors observed a 29 percent increase in CRS use
for children under the age of 9 years with a concomitant 27 percent decrease in seat belt
use. The authors concluded that the emphasis on appropriate child restraint use for older
children had a significant impact on child passenger protection in the United States.
1.1.3
Educational resources available
Despite the lack of definitive Australian legislation regarding restraints for older children,
there is a wide range of resources available for parents with recommendations on
appropriate child restraints in Australia. In addition to the numerous school-based
programs throughout Australia, there are a number of resources that are available on-line
and as a brochure format from a variety of government, insurance, community and nongovernment organisations (see Table 1). The publications generally encourage rear seating
of children under the age of 12 years. Booster seats are generally recommended for
children up to 26 kg; however some publications do recommend the use of a booster seat
up to 32 kg. One brochure, included in the Holden package, also provides a height
recommendation, recommending booster seats for children greater than 100 cm, but does
not provide an upper height recommendation. On the other hand, the ‘Choose Right Fit
Right’ brochure on the MAA website recommends booster seats for children up to 145cm,
but does not provide a lower height recommendation. Other recommendations in regards to
height state that it is appropriate to move your child to a seat belt once their shoulders are
above the top of the car seat back or head rest, or when their eyes are level with the top of
the seat (ATSB, 2004b; Better Health Victorian Government, 2005). There are also
‘restraint fitting services’ available through a variety of organisations to assist parents in
ensuring that their child restraint is appropriately fitted. In addition to these programs, there
are hire schemes available for infant restraints that target new parents.
Internationally, there are a variety of innovative programs targeted at both parents and
children. The Children’s Hospital of Philadelphia provides on-line videos for parents with
information on when, why and how to use booster and car seats. It provides visual footage
on the correct seat belt position for children in booster seats (www.chop.edu/carseat). The
EUCHIRES campaign in ten European countries is targeted specifically at children. The
campaign centres on the “Goochem” or “Armadillo” gadget, a toy, which makes wearing a
seat belt more enjoyable for children (e.g. see www.gordan-online.de for information on
the Euchires in Germany). The campaign was launched in the Netherlands, and now
extends to Belgium, the Czech Republic, Finland, Germany, Poland, Portugal, Slovenia
and Sweden. Evaluations on the change in behaviour will be undertaken in 2006 and 2007.
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
5
Table 1 Summary of Australian literature on child restraint recommendations
Organisation
MAA
State
NSW
Title
Choose Right
Fit Right
RACV
VIC
Holden
National
Child Restraint
Research –
Implications
for users
A driving force
in child safety
Kidsafe
National
Australian
Transport
Safety Bureau
National
Road and
Traffic
Authority;
Federal Office
of Road
Safety
RACV;
VicRoads
RTA; RACV;
NRMA
Vic/NSW
Format
Fact sheet,
brochures,
posters,
video,
shopping
center
displays
Brochure
Date
N/A
Target
Parents/carers
of children
aged 2 to 6
years
Content
Information to assist parents in
choosing the most appropriate child
restraint. This campaign includes as
well as a fact sheet that targets
parents/carers of children aged 2-6
years.
Contact
MAA:www.maa.nsw.gov.au/
July
2004
Parents
Provides findings of the latest research
and considerations for parents when
buying a booster.
Ph: 1800 134 126 or www.racv.com.au
Package
2001
Parents
Ph: (03) 9647 1111
Fax: (03) 9647 1997
SafeKIDSnow
and the family
car
Road safety –
it’s not child’s
play
Fact sheets
N/A
Parents
Brochure
N/A
NSW
A simple guide
to child
restraints
Brochure
N/A
Parents (of
children
under 5
years)
Parents
Outlines the different restraints and
their features, includes pictures of
correct and incorrect fitting
procedures.
Provides information and tips on all
aspects of car safety relating to
children including car restraints.
Provides information on child
behaviour and protection strategies
Information to assist parents in
choosing the most appropriate child
restraint
Ph: 1800 060 607
VIC
Restraint
fitting stations
– get it right
Buyers guide
to child
restraints
Brochure
2000
Parents
Installation guide for child restraints
and list of fitting stations in Victoria
RACV: (03) 9790 2190
VicRoads: 1300 360 745
Brochure
June
2000
Parents
Advice on rating systems and
recommendations for purchasing
RTA: 1800 060 607
NRMA: (02) 9292 9636
RACV: (03) 9790 2190
Ph: (03) 9427 1008 or www.kidsafe.com.au
Ph: 1800 621 372
Fax: (02) 6274 7922
NRMA
National
The Bub Hub
National
Australian
Transport
Safety Bureau
Queensland
Transport
National
RACQ
QLD
Transport SA
SA
Office of
Road Safety
WA
RACT
WA
Australian
Federal Police
QLD
TAS
ACT
Child and
infant
restraints
Infant car seats
and child
restraints
Website
2004
Parents
Website
N/A
Parents
A simple guide
to child
restraints
Why are child
restraints &
seat belts
important?
Royal
Automobile
Club of
Queensland
Online
brochure
N/A
Parents
Online
brochure
N/A
Parents
website
N/A
Parents
Seat belts and
child restraint
information
Restraint Facts
Online
brochures
N/A
Parents
Website
April
2004
Parents
Child restraint
guide
Constable
Kenny Koala
24-page
guide
Interactive
website
and school
visit
N/A
Parents
Ongoing
Pre-school
and school
aged children
Provides information on the correct
child restraints to use and other
information on child restraints
Provides product information, links to
other organisations, and general
information on car restraints and other
areas of parenting
Information to assist parents in
choosing the most appropriate child
restraint
Information on choosing the right
child restraint for the child and correct
fitment
Links to a report ‘child restraint advice
and fitting service in Queensland’
online shopping for car restraints and
accessories, general information on car
restraints
Provides six brochures on the different
car restraints available for children all
ages
Provides statistics and facts on
restraint use
Provides comprehensive information
on child restraints
General safety program which
includes a road safety component and
the message for children to ‘buckle up’
their seat belts.
www.mynrma.com.au
www.bubhub.com.au
www.atsb.gov.au
www.roadsafety.qld.gov.au
www.racq.com.au
www.transport.sa.gov.au
www.officeofroadsafety.wa.gov.au
www.ract.com.au
www.afp.gov.au/afp/page/Kids/KennyKoala/Home.htm
1.1.4 CRS Use and Misuse
Notwithstanding the shortcomings in Australian legislation, usage rates of child restraints
in Australia are relatively high. Both observational studies and parental reports of CRS use
have found high levels of restraint use for very young children. For example, an
observational study conducted in Australia in 1994 estimated that usage rates exceeded 95
percent (Henderson, Brown & Paine, 1994). However, the survey techniques used to obtain
these estimates do not allow for accurate estimates of correct installation and
appropriateness of restraint for the child (Paine & Vertsonis, 2001). Hence, while
compliance estimates are high, these figures belie a number of errors in CRS use.
Indeed, studies show that inappropriate use and misuse of the fitment of CRS is widespread
(Wren, Simpson, Chalmers, & Stephenson, 2001). Restraint inspection programs carried
out in Australia reveal poor fitting rates and/or serious misuse of CRS. Common errors
posing safety concerns include incorrect placement and loose adjustment of the seat belt
and top tether strap (Paine, 1998; Glanvill, 2000; Paine & Vertsonis, 2001). Glanvill
(2000) reported that 69 percent of the 4600 CRS checked during site inspections carried
out by the Royal Automobile Club of Victoria (RACV) between 1996 and 1999 were
faulty and a disturbing proportion of these (25%) were judged to be major faults. Paine and
Vertsonis (2001) confirmed similar figures for serious, safety-related errors. They reported
that approximately 20 percent of infant capsules and 19 percent of child seats had safetyrelated installation problems. A recent survey of parental attitudes and behaviours in
relation to child restraints also revealed a number of gaps in knowledge about correct use
of child restraints (Glanvill, 2000). For example, many participants did not understand the
risks associated with incorrect installation, using old or damaged restraints or of children
travelling in restraints that are inappropriate for their size.
It is important that as children grow, they use a restraint that is appropriate for their size
(particularly, height and, to a lesser extent, weight) because incorrect and/or inappropriate
fitment and use of restraints may reduce or nullify safety benefits (Boyle & Sharp, 1997;
Henderson, 1994; Paine & Vertsonis, 2001; Winston, Durbin, Kallan & Moll, 2000).
However studies have consistently shown that CRS use decreases with the increasing age
of the child. For example, a recent observational study conducted for the National Highway
Traffic Safety Administration (NHTSA) in four US States reported that CRS usage was 96
percent for infants; 89 percent for children aged between one and four years; and 81
percent for children aged between five and nine years (Decina & Knoebel, 1997).
In addition, a number of researchers have reported that a relatively high proportion of
children ‘graduate’ to seat belts too early. That is, children who grow out of a CRS suitable
for young children move directly into a seat belt rather than using a booster seat (Winston
et al., 2000; Ramsey, Simpson & Rivara, 2000). For example, an observational study
conducted in four states in the United States in 1995 showed that 21 percent of toddlers
(20-40 lb or 9.09-18.18 kg) and 75 percent of preschoolers (40-60lb or 18.18-27.27 kg)
were restrained by a seat belt only (Decina & Knoebel, 1997). In another study, 28 percent
of four year olds, 36 percent of five year olds and 70 percent of six to eight year olds were
restrained by a seat belt only (Ramsey et al., 2000). In addition, Ramsey et al. noted that
more than 50 percent of parents owned the appropriate device but believed, incorrectly,
that their children were large enough for a seat belt.
Although a seat belt provides better protection than no restraint at all (Winston, Chen,
Elliot, Arbogast & Durbin, 2004), premature graduation of young children from CRS to
seat belts puts them at greatly increased risks of significant injury in crashes (Winston et
8
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
al., 2000). When a child is prematurely graduated to a seat belt from a child restraint, the
lap portion of the belt rides up over the abdomen and the shoulder portion crosses the neck
or face. This places the child at risk for submarining or slipping out of the seat belt during a
crash. In addition, rapid, jack knife bending about a poorly positioned seat belt increases
the risk of intra-abdominal and spinal cord injuries, also known as seat belt syndrome and
brain injury resulting from the impact of the head with the child’s knee or the vehicle’s
interior (Gotschall, Better, Blaus, Eichelberger, Bents & Warner, 1998; Winston et al.,
2000).
Recent studies have attempted to quantify the nature and risk of significant injury
associated with premature graduation to seat belts in preschool aged children. Nance, Lutz,
Arbogast, Cornejo, Kallan, Winston and Durbin (2004) investigated the relationship
between abdominal injuries sustained and restraint appropriateness for children occupants
aged 15 years or younger involved in a motor vehicle crash. Restraint use was categorised
as appropriate/‘optimal’ or inappropriate/‘sub-optimal’ based on current American
Academy of Pediatrics guidelines. Abdominal injury was defined as any reported injury to
an intra-abdominal organ of AIS2+ severity. The authors noted that restraint use was
optimal for 59 percent of child occupants (n = 120,473) and suboptimal for 41 percent of
child occupants (n = 83,555). An associated abdominal organ injury was noted in 0.05
percent (n = 62) of the optimally restrained group and in 0.17 percent (n = 140) of the suboptimally restrained group. After adjusting for age and seating position (front vs. rear),
optimally restrained children were more than 3 times less likely than sub-optimally
restrained children to sustain an abdominal injury (OR: 3.51 95% CI 1.87-6.60, P < 0.001).
The authors reported a peak in abdominal injuries for children aged between 4 and 8 years
that coincided with the age group that was least likely to be optimally restrained. In
addition, the authors noted that there were no abdominal injuries reported among optimally
restrained 4 to 8 year olds.
Winston et al. (2000) reported that once involved in a motor vehicle crash, children aged
two to five years who were restrained in a seat belt were 3.5 times more likely to sustain a
significant injury (RR: 3.5; 95% CI 2.4-5.2) and 4.2 times more likely to sustain a
significant head injury (RR: 4.2; 95% CI 2.6-6.7) compared with children in child
restraints. Similarly, Durbin et al. (2003) recently reported that booster seat restraints
reduced the risk of head and brain injuries, all internal organ injuries, spinal cord injuries
and extremity fractures by 59 percent when compared with seat belt restraint in four to
seven year old children. In particular, the authors observed that booster seats virtually
eliminated the ‘seat belt syndrome’ in these children; that is, injuries to the abdominal
organs, lumbar spine and spinal cord. This analysis was conducted on a study sample that
included all directions of impact, however 50 percent of the crashes were frontal crashes.
Similar findings have been reported in Australia. Brown, Bilston, McCaskill and
Henderson (2005) recently investigated the injuries sustained by children aged 2 to 8 years
following involvement in a motor vehicle crash. The authors reported that while most
children within the sample used some form of restraint, the vast majority (over 80%) were
using a sub-optimal form of restraint. In addition, the authors reported that the likelihood
of a child being optimally restrained appeared to decrease after the age of 2 years. The
authors noted that the most significant observation made from their study was that suboptimal restraint was associated with more injury and, for those injured, more serious
injury than those who were optimally restrained (p < 0.001).
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
9
More recently, Arbogast, Kallan and Durbin (2005) quantified that relative effectiveness of
booster seats compared to seat belts in reducing the risk of injury among 4 to 8 year olds in
side impact crashes. Using data from a large child specific crash surveillance system, the
authors reported that children travelling in booster seats had a 58 percent lower risk of
injury than those travelling in a seat belt in a side impact crash (OR: 0.42; 95% CI 0.210.83). In addition, the authors noted this finding varied by booster seat type: those in a high
back booster seat were at a 70 percent reduction in injury risk (OR: 0.30; 95% CI 0.130.68), while those in backless boosters (or booster cushions) did not experience a
statistically significant reduction in injury risk compared to those in seat belts (OR: 1.17;
95% CI 0.40-3.43). The authors suggested that this result may be due to geometric
differences between the two types of booster seats: namely the presence of a specific belt
path for the shoulder belt and the contoured back of the high back booster seat which may
serve to better contain the occupant in these crashes, thus resulting in better protection.
The European Enhanced Vehicle-Safety Committee Working Group on Child Safety
examined a series of European crash databases, including Child Restraint STandard
(CREST – European collaborative research project), German In Depth Accident Study
(GIDAS), GDV (German Insurance), International Road Traffic and Accident Database
(IRTAD - German) and Laboratory of Accidentology and Biomechanics (LAB – France)
to determine the most important body region in terms of frequency of severe injuries for
children in the booster seat age group (Lesire, Guillemot & de Jager, 2005). The authors
reported that, for booster seat aged children, the head and abdominal areas were the body
regions that were the most frequent seriously injured in the event of a crash, and therefore
should be given priority in terms of improved booster design to ensure good protection.
As outlined earlier, rear seating of children under the age of 12 years is generally
encouraged in Australia. In 2005, Lennon conducted a study to estimate the proportion of
Australian children who travel in the front seat of passenger vehicles. Lennon observed
1,295 passenger vehicles carrying child passengers in the State of Queensland and reported
that approximately 60 percent of passenger vehicles carrying children had at least one child
aged 12 years or younger travelling in the front seat. In addition, most children sitting in
the front seat were observed to be restrained by a seat belt (95%). Lennon also reported
that increasing age was associated with a greater likelihood of sitting in the front seat, with
most children front seat passengers aged between 7 and 12 years.
Several studies have evaluated the relative safety benefits of seating position and CRS
effectiveness. Braver, Whitfield and Ferguson (1998) estimated that rear seating reduced
the risk of death by 36 percent for children involved in fatal crashes, regardless of whether
the child was restrained. In addition, Berg, Cook, Corneli, Vernon & Dean (2000)
demonstrated that children in the rear seats were 1.7 times less likely (95% CI 1.6-2.0) to
suffer a fatal or severe injury than front seat child occupants. Both of these studies included
children aged up to 12 or 14 respectively, so they encompass ages when child restraints
and seat belts are recommended.
Durbin, Chen, Smith, Elliot & Winston (2005) investigated children under the age of 16
years who were involved in crashes of insured vehicles in 15 US States. Based on these
crashes, Durbin et al. reported that inappropriately restrained children travelling in the
front seat were at the highest risk of injury and appropriately restrained children travelling
in the rear were at the lowest risk, for all age groups. Inappropriately restrained children
were at nearly twice the risk of injury compared with appropriately restrained children (OR
= 1.8, 95% CI 1.4-2.3). The authors noted that the effect of seating position was smaller
10
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
than the effect of restraint status; children in the front seat were at 40 percent greater risk of
injury, compared with children in the rear seat (OR = 1.4 95% CI 1.2-1.7).
Previous research has also shown that there are different safety benefits associated with
different restraint types and seating positions within the rear seat/row. For example,
Arbogast, Durbin, Kallan and Winston (2004) have recently shown that belted children in
the centre rear seating position of passenger vehicles equipped with a lap shoulder belt are
81 percent less likely to sustain serious injury than those belted in the centre rear equipped
with a lap belt only (adjusted OR = 0.19 95% CI 0.04-0.92). In addition, Maltese, Chen
and Arbogast (2005) reported that child occupants aged 4 to 15 years restrained in seat
belts in the rear rows of passenger vehicles involved in side impacts were at an increased
risk of injury if they were sitting alone on their row compared to sitting with other
occupants. More specifically, center seated child occupants were 75 percent less likely to
be injured if there was another occupant between them and the crash compared to if they
were seated alone (OR: 0.25; 95% CI 0.07-0.93). In addition, child occupants seated in any
other seat in the row occupied were at a 58 percent lower risk of injury compared to those
that were seated alone (OR: 0.42; 95% CI 0.23-0.75). Most recently, Brown et al. (2005)
have reported that children in the rear seat sustained significantly less severe injury than
children in the front seat (p < 0.05).
1.1.5
Factors that influence booster seat use
It is likely that determinants of CRS wearing behaviour are multifactorial and complex.
In a comprehensive review of the underlying explanations for the inappropriate use of
restraints, particularly by the “booster seat age group”, Eby and Kostyniuk (1999)
identified several factors that have been found to be related to the frequency of CRS use:
•
There is a positive relationship between driver seat belt use and CRS use (Decina &
Knoebel, 1996).
•
CRS use tends to be higher for children who travel frequently in the vehicle than
for children who travel less than once per week with the driver (Margolis,
Wagenaar & Molnar, 1992).
•
When a parent or other family member is the vehicle driver, CRS use is higher than
when the driver is a non-family member (Margolis et al., 1992; Decina & Knoebel,
1996).
•
CRS use also tends to be higher in the second row of a vehicle than in either the
front row or third row (in the case of minivans) of seats (Decina & Knoebel, 1996;
Stoke, 1997).
•
Race seems to influence use of CRSs, with Caucasian drivers showing higher use
than African American drivers (e.g. Wagenaar, Molnar & Margolis, 1988; Margolis
et al., 1992).
•
A positive relationship has also been found with driver socioeconomic status
(education and income) and frequency of CRS use (Wagenaar et al., 1988; Russell,
Kresnow & Brackbill, 1994).
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
11
CRS use is also reported to be generally higher for younger children and for children from
smaller families (Durbin Cornejo, Chen, Williams, & Wells, 2003).
In 2005, Eby, Bingham, Vivoda and Ragunathan conducted a state-wide survey of booster
seat use by children aged 4 to 8 years in the State of Michigan. In their study, the authors
reported that they observed 3,420 children while travelling in passenger vehicles,
vans/minivans, sports-utility vehicles and pickup trucks. Overall, nine percent of the four
to eight year old children were travelling in a booster seat, 49 percent were wearing a seat
belt, five percent were travelling in a forward facing child restraint and 38 percent were
travelling unrestrained. When examining the rates of restraint use by vehicle type, booster
seat use was highest amongst children travelling in sports utility vehicles (14%) and lowest
for those in pickups (2%). The authors were surprised to note that children travelling in
passenger vehicles were more likely to be travelling unrestrained than those in any other
type of vehicle. While the gender of the driver did not influence the restraint use of
children, the driver’s age did appear to have an effect. Booster seat use was very low for
children travelling with a driver over the age of 60 years (1%) compared to those travelling
with drivers aged 16-29 years (7%) and 30-59 years (9%). The restraint use of the driver
also had a substantial influence on children’s restraint use. Children travelling with
restrained drivers were more likely to be travelling in a booster seat (10%) compared to
children travelling with unrestrained drivers (1-2%).
In addition, several studies have identified a number of ‘parental barriers’ to using booster
seats including: cost, the need to accommodate other children in the vehicle, the belief that
seat belts provide adequate protection, a lack of knowledge about the importance of
appropriate restraints, as well as a young child’s desire to act grown up and not to have to
sit in any type of restraint (Rivara, Bennett, Crispin Kruger, Ebel, & Sarewitz, 2001;
Winston et al., 2004). Previous research has also indicated that parents appear to be
confused about the appropriate age and weight thresholds for transition from a child
restraint to a booster seat, as well as the transition from a booster seat to a seat belt (Rivara
et al., 2001).
However, while the extent of the problem and the underlying explanations for the
inappropriate use of restraints, particularly by the “booster seat age group” has received
considerable attention internationally, this has not been well researched in Australia.
1.1.6
Summary and Aims of the Current Study
In sum, booster seat usage rates and the underlying explanations for inappropriate use of
restraints (i.e., seat belts) is not well researched in Australia. While the call for better
legislation and public awareness has gathered momentum internationally, Australia appears
to be lagging behind Europe and the United States in addressing the issue of appropriate
restraint use for older children.
The current study was designed to gather more knowledge about restraint usage rates,
patterns of restraint usage and ‘appropriateness’ of restraint use by children in the ‘booster
seat age’, as well as the attitudes of parents of children in the booster seat age group
towards restraint wearing behaviour.
12
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
2 SURVEY OF THE FACTORS THAT INFLUENCE
‘APPROPRIATE’ RESTRAINT USE IN THE BOOSTER SEAT
AGE GROUP
In order to investigate the ‘appropriateness’ of restraint use, as well as Australian parental
attitudes and behaviours in relation to their children’s restraint use, a self-administered
questionnaire was sent to parents of booster seat aged children (i.e., 4-11 years) in the
States of New South Wales and Victoria. More specifically, the questionnaire asked
parents to identify usage rates and patterns of restraint use by children of booster seat age
as well as the factors that influenced their transition into a booster seat and/or into a seat
belt. A detailed description of the study’s methodology, including a description of the
recruitment phase, development of the questionnaire and procedure is outlined below.
2.1
2.1.1
METHOD
Participants and Recruitment
Participants in this study were defined as individuals with a child or children aged between
4 and 11 years and who had a valid driver’s licence. Potential participants were recruited
from the States of New South Wales and Victoria. The recruitment methods for
participants from each State are outlined below. The procedure for New South Wales is
outlined first, followed by the procedure for Victoria.
2.1.1.1 Recruitment in New South Wales
In order to recruit parents of ‘booster seat aged’ children in New South Wales, it was first
necessary to seek approval from the New South Wales Department of Education and
Training. Once approval was received from the Department, an email was sent to each
New South Wales regional director inviting them and their schools to participate in the
study. Figure 3 shows an outline of the school district regions in New South Wales.
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
13
Figure 3 School regions in New South Wales
Interested New South Wales regional directors were then asked to email all public
(primary) school principals in their region to invite them to participate in the study (see
Appendix 1).
Following receipt of a letter of invitation, New South Wales primary school principals who
agreed for their school to participate were asked to contact the research staff at the Monash
University Accident Research Centre to discuss the study in greater detail and/or to
organise for the questionnaires to be sent to their school for distribution.
Table 2 summarises the participating primary schools in each region and the number of
questionnaires sent to each school for distribution.
14
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
Table 2 New South Wales public (primary) schools that agreed to participate
Name of School
School Region
Niangala Primary School
Nemingha Public School
Ballimore Public School
Orana Heights Public School
Tullamore Central School
Sofala Public School
Breadalbane Public School
Woonona Public School
Coledale Public School
Goulburn South Public School
Dapto Public School
Gwynneville Public School
Dalgety Public School
Vincentia Public School
Port Kembla Public School
Kangaroo Valley
Wardell Public School
Hastings Public School
Mallaway Public School
Jasper Road Public School
Beaumont Hills Public School
Thirlmere Public School
Ringrose Public School
Guildford West Public School
Camden South Public School
TOTAL
Number of
Surveys
distributed
New England and Central School
Region
12
New England and Central School
Region
110
Western Region
10
Western Region
250
Western Region
36
Western Region
6
Illawarra/South Coast
10
Illawarra/South Coast
250
Illawarra/South Coast
62
Illawarra/South Coast
8
Illawarra/South Coast
250
Illawarra/South Coast
130
Illawarra/South Coast
20
Illawarra/South Coast
206
Illawarra/South Coast
150
Illawarra/South Coast
72
North Coast
42
North Coast
250
North Coast
20
Western Sydney
100
Western Sydney
100
South Western Sydney
10
South Western Sydney
100
South Western Sydney
250
South Western Sydney
100
2554
Once the primary school principals received their ‘questionnaire packs’, they were asked to
send a Letter of Invitation to parents (see Appendix 2), a Questionnaire (see Appendix 3)
and an Expression of Interest for future research form (see Appendix 4) home to all the
households of attending students.
2.1.1.2 Recruitment in Victoria
The recruitment procedure for Victorian parents of booster seat aged children was slightly
different to that outlined above for New South Wales.
Initially, approval was sought from the Department of Education and Training Victoria to
‘conduct research in schools’. Once approval was received from the department, Victorian
primary schools were randomly selected within each region and sent a letter of invitation to
participate in the study (see Appendix 1). Figure 4 shows an outline of the school district
regions in the State of Victoria.
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
15
Loddon
Campaspe-Mallee
Central
Highlands
Wimmera
Goulburn North Eastern
Gippsland
Barwon South Western
Eastern Metropolitan
Western Metropolitan
Southern Metropolitan
Northern Metropolitan
Figure 4 School regions in Victoria
Interested Victorian primary school principals were asked to contact the research staff at
the Monash University Accident Research Centre, to discuss the study in greater detail
and/or to organise for some questionnaires to be sent to the school for distribution.
A list of the Victorian primary schools that agreed to participate in the study, as well as the
number of questionnaires sent to each school is shown below in Table 3.
Table 3 Victorian primary schools that agreed to participate
Name of School
School Region
Minyip Primary School
Newborough Primary School
Killara Primary School
Thomas Mitchell Primary School
Wangaratta West Primary School
Toolangi Primary School
Mont Albert Primary School
TOTAL
Central Highlands Wimmera
Gippsland
Northern Metropolitan
Southern Metropolitan
Goulburn North Eastern
Eastern Metropolitan
Eastern Metropolitan
Number of
Surveys
Distributed
12
200
250
100
250
15
578
1405
Consistent with the procedure outlined above for New South Wales, Victorian primary
school principals were asked to send a Letter of Invitation to parents (see Appendix 2), a
Questionnaire (see Appendix 3) and an Expression of Interest for future research form (see
Appendix 4) home to all the households of attending students.
2.1.2
Questionnaire
A questionnaire was developed to gather information on restraint usage rates, patterns of
use and ‘appropriateness’ of restraint use by children in the ‘booster seat age range’, as
well as the attitudes of parents towards restraint wearing behaviour. The questionnaire was
16
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
designed to be self-administered (in approximate 20 minutes) by parents and was posted to
researchers anonymously.
The questionnaire (see Appendix 3) comprised three sections:
1) Section A: All parents completed the first section. This section asked parents to
answer questions on their restraint use, their children’s restraint use, their travel
patterns, their motor vehicle crash history as well as a range of demographic
questions. These questions were included in the questionnaire because they may be
a factor influencing children’s restraint use.
Parents were then asked to complete Section B and/or Section C.
2) Section B: Parents completed the second section if they had a child aged 4 to 11
years who was currently travelling in a booster seat. Parents were asked to answer
questions about how they had acquired the booster seat, if they obtained
information about the booster seat, the factors that were important to them when
choosing their booster seat and questions regarding their child’s transition from a
forward facing child restraint into a booster seat and their child’s anticipated
transition from a booster seat into a seat belt.
3) Section C: Parents completed the third section if they had a child aged 4 to 11 years
who was currently travelling in a seat belt. In this section, parents were asked to
answer questions about their child’s transition from a child restraint or booster seat
into a seat belt.
2.1.3
Procedure
In the Letter of Invitation sent home to the households of attending students (see Appendix
2), parents of a child or children aged 4 to 11 years were asked to complete the written,
self-administered questionnaire. Parents were informed in the letter that they could
complete the questionnaire at a time and place convenient for them and to return the
completed questionnaire to the researchers at the Monash University Accident Research
Centre using the reply-paid envelope provided in the ‘questionnaire pack’.
In addition, parents were informed in the Letter of Invitation that researchers at the Monash
University Accident Research Centre were planning to investigate other aspects of child
restraint safety in the future and that if they would like to take part in other research
projects being conducted by Monash University Accident Research Centre, they should
complete the details in the Expression of Interest Form (see Appendix 4).
The procedure was the same for parents from both New South Wales and Victoria.
2.1.4
Analyses
Parents’ responses to the questionnaire were summarised using descriptive statistics. These
analyses included the frequency of ‘appropriate child restraint use’ as determined by
criteria based on the current recommended guidelines. Relevant univariate analyses (e.g. ttests and chi-squares) were conducted to compare appropriate child restraint use across
variables of interest including place of residence (rural, urban; Victoria, New South
Wales), age of child, education level and income of the parent, type of trip, duration of trip,
etc. In addition, more sophisticated logistic regression modelling was conducted to
ascertain the relative importance of these variables in predicting ‘appropriate’ restraint use.
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
17
3 RESULTS
The next section of the report describes the findings from the parents’ responses to the
questionnaire. The first section describes participants’ responses to the demographic
section of the questionnaire, including information regarding their driving habits and crash
history. The second section describes the participants’ responses regarding their children’s
use of booster seats and their child’s transition from a child restraint to a booster seat. The
third section describes the participants’ responses regarding their children’s use of adult
seat belts, including their child’s transition from a booster seat to a seat belt.
3.1
RECRUITMENT RATES
As outlined above in Table 1 and Table 2, questionnaire packs were sent out to 3,959
parents with a child or children aged between 4 and 11 years – 2,554 questionnaires were
sent to parents in New South Wales (65%) and 1,405 questionnaires were sent to parents in
Victoria (35%).
Of the 3,959 questionnaires sent out, 699 questionnaires were completed and returned to
the researchers at Monash University Accident Research Centre (17%). Nineteen percent
of parents in New South Wales and 15 percent of parents in Victoria completed and
returned their questionnaire.
3.2
SECTION A: DEMOGRAPHIC AND DRIVING INFORMATION
The following analyses are based on Section A of the questionnaire. This section of the
questionnaire was designed to elicit some demographic information about the parents who
completed the questionnaire, as well as some information about their driving habits and
crash and infringement history. All parents who participated in this study completed this
section of the questionnaire. The analyses below are based on responses from 699
participants from both New South Wales and Victoria.
3.2.1
Demographic Information
First, participants were asked to indicate their age, gender and marital status. Most of the
participants who completed the questionnaire were female (88%), were aged between 31 to
45 years (83%) (see Figure 5) and were married (78%) (see Figure 6).
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MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
40
35
Percentage
30
25
20
15
10
5
0
18-25
26-30
31-35
36-40
41-45
46-49
50+
Figure 5 Age groups (years) of participants who completed the questionnaire
90
80
70
Percentage
60
50
40
30
20
10
0
Married
Defacto
Single
Divorced
Separated
Widowed
Figure 6 Marital status of participants who completed the questionnaire
Participants were also asked several questions about their place of residence. Most
participants who completed the questionnaire lived in the State of New South Wales
(70%), with the remaining participants living in the State of Victoria (30%). In addition, as
shown in Figure 7, just over one third of participants reported that they lived in a
metropolitan area (36%), just over one quarter of participants reported that they lived in a
regional city, just over one quarter of participants reported that they lived in a country town
and the remainder reported that they lived in a rural area.
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
19
40
35
Percentage
30
25
20
15
10
5
0
Metro
Regional city
Country town
Rural area
Figure 7 Place of residence for participants who completed the questionnaire
Participants were then asked about their about their annual household income (before tax).
As shown in Figure 8, most participants indicated that their annual household income was
between $41,000 and $75,000 per year.
35
30
Percentage
25
20
15
10
5
0
< $20,000
$20,000 $40,000
$41,000 $75,000
$76,000 $100,000
> $100,000
Figure 8 Annual household income for participants who completed the questionnaire
Participants were also asked about the highest level of education that they had reached. As
shown in Figure 9, most participants indicated that they had finished technical school or a
TAFE course (26%) or a higher degree (26%).
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MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
Other
Higher degree
Degree from Uni
Finished technical school or TAFE
Finished HSC/VCE
Finished intermediate (Year 10)
Finished primary school
0
5
10
15
20
25
30
Percentage
Figure 9 Highest level of education reached for participants who completed the
questionnaire
The demographic characteristics of the participants were compared to the demographic
characteristics of parents with at least one child under the age of 15 years reported in the
2001 Australian Bureau of Statistics Census data (2001) (see Table 4).
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
21
Table 4 Representativeness of the Demographic characteristics for participants
Demographic Characteristics
Gender
Age Group
Marital Status
State of Residence
Place of Residence
Household Income
Highest Level of
Education
Female
Male
18 - 30 years
31 - 45 years
46 + years
Married/Defacto
Single
Divorced
Separated
Widowed
NSW
VIC
Metropolitan
Regional city
Country town or Rural area
< $20,000
$20,000 - $40,000
$41,000 - $75,000
$76,000 - $100,000
> $100,000
Income not stated
% of
current
sample
88
12
9
83
9
86
4
5
5
0
70
30
36
28
27
7
18
33
22
20
0
ABS
Census
data%*
55#
45#
11
76
13
81
9
5
4
1
58
42
66
17
17
9
23
38
15
12
2
Finished intermediate education
Finished secondary education
Univ. degree or higher
Other
20
43
33
4
40
27
18
15
*Source: Australian Bureau of Statistics (2001).
#NB: Gender data derived from ABS Cat 4102.0 Australian Social Trends Data Cube (based on 2003 data),
additional information on the gender of same-sex couples and single parent families was derived from the
Australian Yearbook 2005
As shown in Table 4, the comparison revealed that, compared to the information provided
by parents in the 2001 Census, parents in the current sample were more likely to be:
female; residing in metropolitan areas and in the State of NSW; and more likely to have
completed secondary school or a university degree. However, it should be noted that the
sample was relatively representative of the population on the remaining variables,
including age, marital status and household income.
Participants were asked to indicate the type of vehicle typically driven while travelling
with their children. As shown in Figure 10, most participants reported a four door sedan
was the type of vehicle typically driven while travelling with their children (44%).
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MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
Other
People mover/van
4 wheel drive
Station wagon
4 door hatchback
2 door hatchback
4 door sedan
2 door sedan
0
10
20
30
40
50
Percentage
Figure 10 Type of vehicle typically driven by participants when travelling with their
children
Participants also reported that they typically drove less than 100 kilometres per week with
their children (see Figure 11), that most of their trips were between five and ten kilometres
(see Figure 12), that they usually drove their children daily or almost daily (see Figure 13)
and that they were the person who drove their children the most (see Figure 14).
70
60
Percentage
50
40
30
20
10
0
< 100 km
101-200 km
201-500 km
> 501 km
Figure 11 Kilometres driven with children per week for participants who completed
the questionnaire
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
23
60
50
Percentage
40
30
20
10
0
> 10 km
5 - 10 km
3 - 5 km
< 3km
Figure 12 Average trip length driven with children for participants who completed
the questionnaire
90
80
Percentage
70
60
50
40
30
20
10
0
Daily or almost
daily
2 or 3 times a week
Once a week
Once a month
Figure 13 Frequency of driving with children for participants who completed the
questionnaire
24
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
100
90
80
Percentage
70
60
50
40
30
20
10
0
Themselves
Their partner/
husband/wife
Grandparents
Their
friend/neighbour
Figure 14 Person who does most of the driving with children for participants who
completed the questionnaire
3.2.2
Restraint Use
The next section of the questionnaire was designed to investigate participants’ restraint use
and their children’s restraint use while travelling in a vehicle.
Participants were asked how often they wear their seat belt while travelling in a vehicle
(‘always/mostly/sometimes/never/not sure’). Almost all parents (99%) indicated that they
‘always’ wore their seat belt while travelling in a vehicle. Similarly, when participants
were asked to indicate how often their children were restrained in their vehicle, 99 percent
reported that their children were ‘always’ restrained.
Participants were then asked if there were any circumstances under which they would
allow their child/children to travel while not restrained (either by a child restraint or a seat
belt). Less than one percent of parents indicated that they would allow their child/children
to travel unrestrained if: travelling at night, their child was asleep, or their child refused to
use the restraint. Less than two percent of parents indicated that they would allow their
child/children to travel unrestrained if: their child’s peers were travelling in the vehicle or
their child was travelling in someone else’s vehicle. Just fewer than four percent of parents
indicated that they would allow their child/children to travel unrestrained if there were not
enough restraints for all passengers.
3.2.2.1 Child occupant information, including type of restraint use and seating position
Participants were asked to record their child’s/children’s age, weight, height, current
restraint used and typical seating position. The following details are provided for all
children aged between 4 and 11 years (see Table 5).
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
25
Table 5 Children’s Age, Weight, Height and Seating position by Restraint Type
Booster Seat
Seat Belt
Number
237 (24%)
751 (76%)
Age
Mean = 5.84 years (SD = 1.19)
Mean = 8.18 years (SD = 1.84)
Range = 4 – 10 years
Range = 4 – 11 years
Male = 52%
Male = 53%
Female = 48%
Female = 47%
Mean = 21.87 kg (SD = 8.62)
Mean = 30.35 kg (SD = 9.51)
Range = 13 – 35 kg
Range = 12 – 78 kg
Mean = 115.15 cm (SD =11.53)
Mean = 130.53 cm (SD = 15.63)
Range = 48 – 157 cm
Range = 45 – 200 cm
Booster seat = 117 (49%)
Seat belt – sash/lap = 716 (95%)
Booster cushion = 120 (51%)
Seat belt – lap only = 35 (5%)
Car front passenger = 24%
Car front passenger = 21%
Car rear left = 8%
Car rear left = 7%
Car rear right = 3%
Car rear right = 8%
Car rear centre = 26%
Car rear centre = 24%
Station wagon front passenger = 13%
Station wagon front passenger = 7%
Station wagon middle left = 4%
Station wagon middle left = 5%
Station wagon middle centre = 11%
Station wagon middle centre = 7%
Station wagon middle right = 2%
Station wagon middle right = 3%
Station wagon rear = 1%
Station wagon rear = 2%
Van front passenger = 0%
Van front passenger = 0%
Van middle left = 3%
Van middle left = 4%
Van middle centre = 3%
Van middle centre = 5%
Van middle right = 0%
Van middle right = 4%
Van rear left = 3%
Van rear left = 5%
Van rear centre = 0%
Van rear centre = 0%
Van rear right = 0%
Van rear right = 0%
Gender
Weight
Height
Restraint Type
Seating position
The findings from the questionnaire revealed that children in the booster seat age range
were more likely to be restrained by a seat belt (76%) compared to a booster seat (24%).
Children travelling in booster seats were significantly younger, lighter in weight and
shorter in height than children traveling in a seat belt (Age: t(617.75) = 22.964, p < 0.001;
Weight: t(398.49) = 12.25, p < 0.001; Height: t(430.94) = 14.50, p < 0.001). In addition,
children travelling in a booster seat were significantly more likely to be sitting in the front
passenger position (for all vehicle types) (38%) compared to children travelling in a seat
belt (28%), χ2(1) = 8.157, p < 0.01.
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MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
An important aim of this study was to determine if children aged between 4 and 11 years of
age were restrained appropriately. While there is no current Australian legislation
regarding the appropriateness of restraints for older children, there are some Australianbased guidelines and international recommendations and legislation indicating
appropriateness of restraint use based on approximate age, weight and/or height measures.
While there are some small variations in these guidelines, for the purpose of the current
study, the criterion selected was a relatively conservative measure: Children were
appropriately restrained in a booster seat if their height was more than 100 centimetres and
less than or equal to 140 centimetres, while children travelling in a seat belt were
appropriately restrained if their height was more than 140 centimetres (i.e., NHTSA, 2001).
The children’s height, rather than their age or weight, was used to assess appropriateness
because their height governs the positioning of the lap/shoulder seat belt across the child’s
shoulder and hips. Based on the height measurements provided by parents, children
travelling in a booster seat were significantly more likely to be appropriately restrained
(93%) compared to children travelling in a seat belt (25%), χ2(1) = 266.940, p < 0.001.
That is, according to the current recommendations, 75 percent of children in the current
study were too short to be ‘appropriately’ restrained by a seat belt. Figure 15 shows the
proportion of booster seat aged children restrained ‘appropriately’ by age.
80
70
Percentage
60
50
40
30
20
10
0
4
5
6
7
8
9
10
11
Age (years)
Figure 15 Proportion of booster seat aged children ‘appropriately’ restrained by age
As shown in Figure 15, the youngest children (4 years) and oldest children (10 and 11
years) were most likely to be restrained ‘appropriately’ (74%, 66%, 68%, respectively),
whereas children aged 7 and 8 years were least likely to be appropriately restrained (15%
for each age group).
As outlined earlier, children travelling in a booster seat were significantly more likely to be
sitting in the front passenger position in their vehicle compared to children travelling in a
seat belt. Previous research has reported that children travelling in the front seat are
significantly more at risk of sustaining an injury in the front seat compared to if they were
sitting in the rear seat. Consequently, a second measure of children’s ‘restraint
appropriateness’ was calculated, incorporating seating position. That is, children were only
considered to be travelling appropriately if their height met the height criteria and they
were not traveling in the front seat (for both booster seats and seat belts). Once seating
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
27
position was taken into account, the proportion of children travelling in a booster seat
appropriately decreased from 93 percent to 51 percent. Similarly, the proportion of
children travelling appropriately in a seat belt decreased from 25 percent to 15 percent,
once seating position had been taken into account.
Nevertheless, children travelling in a booster seat were significantly more likely to be
appropriately restrained and sitting in a middle or rear seat (51%) compared to children
travelling in a seat belt (15%), χ2(1) = 101.776, p < 0.001.
Participants were asked to indicate if there were any circumstances when their children’s
seating positions changed from its typical position. Table 6 shows reasons why children’s
typical seating positions changed.
Table 6 Reasons that children’s typical seating positions differed
Seating positions changes if:
Percentage
There is more than one adult travelling in 29%
the vehicle
Travelling on long trips
19%
Travelling on short trips
20%
Other children are travelling in the vehicle
38%
Other reasons
16%
As shown in Table 6, participants indicated that their children’s seating positions typically
changed when other children were travelling in the vehicle (38%) or when an adult was
travelling in the vehicle (29%). For both of these scenarios, parents indicated that the
children who typically sat in the front seat generally moved to the back seat to sit with their
peers or give the front seat to the adult.
Parents were presented with a series of statements to determine how much they understood
about restraining their child while travelling in a vehicle. Most parents agreed with the
following statements:
28
•
Babies should travel in a specially fitted capsule (97%);
•
Children under the age of 8 years should not sit in the front seat (78%);
•
The main benefit of the booster is that the child can sit at a height so that the seat
belt is positioned properly (85%);
•
Some child restraints are safer than others (59%), and
•
There are laws in my State against travelling with unrestrained passengers (97%).
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
3.2.3
Motor Vehicle Crashes
Participants were asked to indicate if they had been involved in a motor vehicle crash in
the past two years, after which the vehicle had to be towed away. Only a small proportion
of participants (5%) reported that they had been involved in a motor vehicle crash in the
past two years. In addition, 54 percent of participants indicated that their children were
passengers in the vehicle at the time of the crash. Finally, most participants indicated that
there were ‘no injuries’ sustained in the crashes (65%), with some participants indicating
that at least one passenger sustained minor or serious injuries (23%, 7%, respectively).
3.3
SECTION B: CHILDREN’S USE OF BOOSTER SEATS
The following analyses are based on Section B of the questionnaire. Parents completed this
section of the questionnaire if they had a child aged 4 to 11 years currently restrained in
their vehicle by a booster seat 1 . The analyses below are based on responses from 243
parents from both New South Wales and Victoria.
Firstly, parents were asked to provide the age, gender, weight and height for the child who
had most recently moved into a booster seat:
•
The mean age for children travelling in a booster seat was 5.37 years (SD = 1.27
years), with children’s ages ranging from 1.58 to 10.33 years.
•
There were approximately equal proportions of male and female children (46%,
56%, respectively).
•
The mean weight was 20.31 kilograms (SD = 4.05 kg), with the children’s weights
ranging from 12 to 35 kilograms.
•
The mean height was 111.83 centimetres (SD = 12.90 cm), with the children’s
heights ranging from 48 to 156 cm.
A simple calculation was performed to determine if children were being appropriately
restrained in their booster seats. Based on the height measurements provided by parents, 85
percent of children were being appropriately restrained in a booster seat according to the
current restraint guidelines (i.e., their height was more than 100 centimetres and less than
or equal to 140 centimetres).
Parents were asked to indicate how often their child was restrained while travelling in a
vehicle (see Figure 16).
1
Parents with more than one child aged 4 to 11 years were instructed to answer this section of the
questionnaire with regard to the child who had most recently moved into a booster seat.
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
29
90
80
70
Percentage
60
50
40
30
20
10
0
Always
Mostly
Sometimes
Not sure
Figure 16 Frequency of booster seat use
As shown in Figure 16, the majority of parents reported that their child was ‘always’
restrained in a booster seat (78%).
Parents were then asked if there were any circumstances under which they would allow
their child to travel in a vehicle without a booster seat (just in a seat belt) (see Figure 17).
Parents were instructed to indicate as many circumstances as appropriate.
Not enough restraints
Someone else's vehicle
Short trips
Child's peers
Child refuses
Child asleep
At night
0
5
10
15
20
25
30
35
40
45
Percentage
Figure 17 Circumstances under which children were allowed to travel in a vehicle
without a booster seat
As shown in Figure 17, most parents indicated that their children were allowed to travel
while not restrained in a booster seat when they were travelling in someone else’s vehicle
(42%) or when they were travelling on short trips (24%).
30
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
Parents were asked to indicate what their child liked and disliked about travelling in their
booster seat. The most popular reason provided by parents was that their child liked being
elevated by the booster seat, and therefore had better visibility out of the window (71%).
Other responses included that the children found the booster seat more comfortable/felt
better restrained (12%) and that the children could rest their head on the booster seat wings
when sleeping (7%).
On the other hand, the most popular reason provided by parents was that their child
disliked the fact that they couldn’t buckle/unbuckle themselves in their booster seat (33%).
In addition, some children felt it was unfair that they had to travel in a booster seat when
siblings or friends did not (22%), that they found the booster seat uncomfortable (22%) or
that they were too big/mature/grown up to travel in a booster seat (20%).
Parents were asked to indicate how they acquired their booster seat. As shown in Figure
18, most parents purchased a new booster seat for their child (77%).
Other
Borrowed/given family
friends
Purchased it 2nd
hand
Purchased it new
0
10
20
30
40
50
60
70
80
90
Percentage
Figure 18 Parents’ acquisition of a booster seat for their child
Parents who purchased their booster seat were then asked if they obtained any information
about the booster seat before purchasing it. Fifty one percent of participants reported that
they did obtain information about the booster seat before purchasing it. Parents who
indicated that they had obtained information about the booster seat were then asked to
indicate the sources of the information that they obtained (see Table 7).
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
31
Table 7 Information sources used when purchasing the booster seat
Information source
Percentage
Maternal and Child Health Centres
20%
Newspapers/Magazines/Brochure/Books
43%
School/Kinder/Playgroup
6%
Word of mouth (family, friend)
32%
RTA/RACV/NRMA Buyers guide
27%
VicRoads/RTA website/brochure
11%
Autoclub website/brochure
8%
Shop where you purchased the restraint
75%
Other (please specify)
1%
As shown in Table 7, most participants indicated that they obtained information about the
booster seat from the shop where they purchased the booster seat (75%). Participants were
then asked to indicate the most useful source of information that they obtained about the
booster seat (see Table 8).
Table 8 Most useful information source used when purchasing the booster seat
Information source
Percentage
Maternal and Child Health Centres
8%
Newspapers/Magazines/Brochure/Books
18%
School/Kinder/Playgroup
3%
Word of mouth (family, friend)
15%
RTA/RACV/NRMA Buyers guide
13%
VicRoads/RTA website/brochure
6%
Autoclub website/brochure
1%
Shop where you purchased the restraint
28%
Other (please specify)
8%
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MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
As shown in Table 8, the most useful sources of information about booster seats were
obtained by parents from the shop where they purchased the booster seat (28%), as well as
information in newspapers/magazines/brochures/books (18%).
Parents who had purchased their booster seat, were then asked to indicate the factors that
were priorities (e.g., high/medium/low) to them when choosing which booster seat to
purchase. As shown in Figure 19, parents were most likely to report that purchasing a
booster seat that met with Australian standards (94%) and that was comfortable for their
child (84%) were the highest priorities in the purchase process. On the other hand, the
lowest priorities for parents included the style/look/colour of the restraint, the weight of the
restraint and the purchase price of the restraint.
Weight of restraint
Thickness of padding
Style/look/colour
Size/fit of restraint in relation to vehicle
Reputation of make/model
Purchase price
Length of time would suit child
Ease of fitting into vehicle
Easy access for parent
Easy access for child
Durability
Comfort for child
Australian standard
High
Medium
Low
0%
20%
40%
60%
80% 100%
Percentage
Figure 19 Factors that were priorities (high/medium/low) in the booster seat
purchase process
In order to determine the most important factor in the booster seat purchasing process,
participants were then asked to rank the factors they had rated as a high priority in order
from highest (1) to lowest. Figure 20 shows the factors that were ranked by participants as
the most important factor in the booster seat purchasing process.
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
33
Weight of restraint
Thickness of padding
Style/look/colour
Size/fit of restraint in relation to vehicle
Reputation of make/model
Purchase price
Length of time would suit child
Ease of fitting into vehicle
Easy access for parent
Easy access for child
Durability
Comfort for child
Australian standard
0
10
20
30
40
50
60
70
80
Percentage
Figure 20 Factors ranked as the highest priority in the booster seat purchase process
As shown in Figure 20, most parents stated that ensuring that the booster seat met with
Australian standards was the most important factor in choosing which booster seat to
purchase.
In order to investigate the factors that had contributed to the decision making process about
when to move their child from a forward facing child restraint to a booster seat,
participants were asked to indicate the reasons why they had moved their child into a
booster seat (see Table 9).
34
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
Table 9 Parents’ reasons for moving their child into a booster seat
Reasons
Percentage
My child was too big for the forward facing child restraint
72%
My child disliked sitting in the forward facing child restraint
14%
I needed the forward facing child restraint for a younger child
23%
My child would be more comfortable in a booster seat compared to a 43%
forward facing child restraint
My child reached upper end of the weight range recommended by the 47%
forward facing child restraint manufacturer
My child would be safer in a booster seat compared to a seat belt
64%
My child thought they were too grown up to sit in a forward facing 14%
child restraint
My child’s shoulders were above the slots for the harness strap
55%
It would be easier to keep my child restrained in a booster seat 21%
compared to a seat belt
A booster provides better visibility for my child compared to a seat 52%
belt
My child had their 4th birthday
7%
My child started kindergarten
5%
My child started primary school
4%
As shown in Table 9, most parents indicated that they had moved their child into a booster
seat because their child was too big for the forward facing child restraint (72%) and because
their child would be safer in a booster seat compared to a seat belt (64%). It was also
interesting to note that factors relating to their child’s size were also popular. For example,
many parents indicated that they had moved their child because their shoulders were above
the slots for the harness strap (55%) and because their child had reached upper end of the
weight range recommended by the forward facing child restraint manufacturer (47%).
Parents were then asked to indicate the most important reasons for moving their child into a
booster seat (see Table 10).
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
35
Table 10 Most important reason for moving their child into a booster seat
Reasons
Percentage
My child was too big for the forward facing child restraint
34%
My child disliked sitting in the forward facing child restraint
1%
I needed the forward facing child restraint for a younger child
6%
My child would be more comfortable in a booster seat compared to a 2%
forward facing child restraint
My child reached upper end of the weight range recommended by the 17%
forward facing child restraint manufacturer
My child would be safer in a booster seat compared to a seat belt
17%
My child thought they were too grown up to sit in a forward facing 1%
child restraint
My child’s shoulders were above the slots for the harness strap
19%
It would be easier to keep my child restrained in a booster seat 1%
compared to a seat belt
A booster provides better visibility for my child compared to a seat 3%
belt
My child had their 4th birthday
1%
My child started kindergarten
0%
My child started primary school
0%
As shown in Table 10, most participants indicated that the most important reason for
moving their child into a booster seat was because their child was too big for their forward
facing child restraint (34%), their child’s shoulders were above the slots for the harness
strap (19%), their child had reached the upper end of the weight range recommended by
the forward facing child restraint manufacturer (17%) and that their child would be safer in
a booster seat compared to a seat belt (17%).
Participants were then asked about their child’s transition from a booster seat to a seat belt.
More specifically, participants were asked to anticipate how they would know when to
move their child into a seat belt. Most participants indicated that they would move their
child into a seat belt when their child reached the upper end of the weight range
recommended by the child seat manufacturer (75%) or when their child’s eyes were level
with the top of the vehicle seat or headrest (47%). On the other hand, ‘events’ such as the
start of kindergarten or primary school accounted for a relatively small proportion of the
reasons for graduating their child to a seat belt. When asked to indicate the most important
reason for moving their child into a seat belt, most parents stated that it would be when
36
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
their child reaches the upper end of the weight range recommended by the child seat
manufacture (47%).
3.3.1
Factors associated with the Appropriate Use of Booster Seats
As outlined earlier, one of the main aims of this study was to determine the factors that
influence appropriate restraint use in the booster seat age group. To determine the
predictive relationship of the factors associated with appropriate use of a booster seat, a
series of univariate logistic regression models were performed. Questionnaire factors with
a statistical significance value of p = 0.25 were accepted, recognising that while a
particular variable may not be highly predictive in the univariate sense, it may influence or
moderate the effect of another variable. It should be noted that ‘annual household income’
appeared to influence the size of the other variables’ odds ratios within the model and
therefore was retained in the model.
The final predictive multivariable model of the factors that influence the appropriate use of
a booster seat involved the analysis of 154 participants (65% of the total sample, n= 237)
and is comprised of the following factors, with relevant odds ratios presented in Table 11:
•
Child’s age;
•
Child’s gender;
•
Child’s weight;
•
Parent’s household income, defined as ‘less than $40,000’, $41,000-$75,000’,
‘more than $75,000’;
•
Average trip distance with children in the vehicle, defined as ‘less than 5km’, ‘more
than 5 km less, than 10km’, ‘more than 10km’
•
Knowledge about child restraints, - ‘I will know to move child from booster seat to
a seat when my child’s eyes are level with the top of the seat or headrest’, defined as ‘true’,
‘false’, ‘don’t know’, and
•
Parents with another child seated in a seat belt.
The multivariable logistic regression model was strongly predictive of the factors that
influence the appropriate use of a booster seat, χ2 (10) =55.7, p ≤ 0.001, with the HosmerLemeshow Goodness-of-fit suggesting good model fit, p ≥ 0.05. The model was seen to
correctly classify 90.91 percent of participants, with the ROC curve indicating ‘good’
discrimination (88%).
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
37
Table 11 Odds ratios (95th %CI) for key parameters associated with factors that
influence the appropriate use of a booster seat
Child Age
Child Weight
2.4
1.33
95th %CI
lowerupper
1.24-4.69
1.06-1.66
Child Gender
Parent’s
household
income
Average Trip
Length
3.44
4.15
1.07-11.05
0.74-23.2
.04
.10
1.26
0.60
0.27-5.91
0.14-2.58
.77
.40
0.19
4.34
9.08
0.03–1.25
1.05-18.01
1.85-44.49
.08
.04
.01
7.63
1.80-32.2
.006
Predictor
Referent
$41,000< $40,000’
$75,000
$75,000+
< $40,000’
> 5km, < > 10km
10km
< 5km
> 10km
Move my child FALSE
TRUE
into a seat belt DON’T
TRUE
when
their KNOW
eyes are level
with top of
seat
or
headrest
With another Parents with Parents with
child in seat another
only
one
belt
child in a child
in
seat
sample
OR
P
.01
.01
Table 11 presents the odds ratios for key parameters associated the appropriate use of a
booster seat. For ease of reading, each is discussed briefly in turn:
38
•
Child age: Every 1 year increase in age was associated with a 2.4 higher likelihood
of being seated appropriately in a booster, OR: 2.4, CI: 1.24-4.69, p < 0.01;
•
Child weight: Every 1 unit increase in weight (kg) was associated with a 1.3 higher
likelihood of being seated appropriately in a booster, OR: 1.33, CI: 1.06-1.66, p <
0.05;
•
Child gender: Female children were 3.4 times more likely to be seated
appropriately than male children, OR: 3.44, CI: 1.07-11.05, p < 0.05;
•
Parent’s household Income: Relative to those ‘earning less than $40,000’, parents
earning between $41,000-75,000 were 4.15 times more likely to appropriately
restrain their child in a booster seat, however this was not statistically significant
OR: 4.15, CI: 0.74-23.2, p = 0.1. There was no significant difference in the
proportion of appropriateness of booster seat use between those earning over
$75,000 and those ‘earning less than $40,000’;
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
•
Trip distance: Relative to participants whose average trip length with their children
was ‘more than 10 km’, parents with an average trip length of ‘less than 5 km’ were
approximately 80 percent less likely to appropriately seat their child in the booster,
although this result was not statistically significant, OR: 0.19, CI: 0.03-1.25, p =
0.08;
•
Knowledge regarding child restraint use - “I will know to move my child from
booster seat to a seat when my child’s eyes are level with the top of the seat or
headrest’: Relative to those parents who answered ‘true’, parents who answered
‘false’ to this question were 4.34 times more likely to use the booster appropriately,
OR: 4.34, CI: 1.05-18.01, p=0.04. In addition, parents who answered ‘don’t know’
were 9 times more likely to use the booster appropriately than those answering
‘true’ to this statement, OR: 9.08, CI: 1.85-44.49, p=0.006, and
•
Parents with another child in a seat belt: Relative to parents with only one child in
the sample, parents with another child in a seat belt were 7.6 times more likely to
use the booster seat appropriately, OR: 7.63, CI: 1.80-32.2, p=0.006.
The definition of ‘appropriate’ seating was derived from the child’s height (height was
therefore not included in the model). This therefore does not account for appropriate
seating in a booster in an inappropriate location in the vehicle, say the front seat. The
confidence intervals on some of the parameters were large, however the overall model fits
well, with the ROC curve indicating ‘good’ discrimination. Evidently, the high proportion
of parents using the booster seats appropriately (83%, n=155) compared to the small
number and proportion of parents using the booster seat inappropriately (16%, n=31) will
ensure some of the CIs are large. These do not detract from their overall levels of statistical
significance.
3.4
SECTION C: CHILDREN’S USE OF SEAT BELTS
The following analyses are based on Section C of the questionnaire. This section of the
questionnaire was completed by parents with a child aged 4 to 11 years, currently
restrained in their vehicle by a seat belt 2 . The analyses below are based on the responses
from 514 parents from both New South Wales and Victoria.
Firstly, parents were asked to provide the age, gender, weight and height for the child who
had most recently moved into a seat belt:
•
The mean age for children travelling in a seat belt was 7.8 years (SD = 1.8 years),
with children’s ages ranging from 3.5 to 11.4 years.
•
There were equal proportions of male and female children (50% for each group).
•
The mean weight was 28.57 kilograms (SD = 8.04 kg), with the children’s weights
ranging from 12 to 70 kilograms.
2
Parents with more than one child aged 4 to 11 years were instructed to answer this section of the
questionnaire with regard to the child who had most recently moved into a seat belt.
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
39
•
The mean height was 127.94 centimetres (SD = 14.75 cm), with the children’s
heights ranging from 45 to 170 cm.
A simple calculation was performed to determine if children were being appropriately
restrained in a seat belt. Based on the height measurements provided by parents, 83 percent
of children were not being appropriately restrained according to the selected height criteria
(i.e., they were not over 140cm).
Participants were asked to indicate the type of restraint that their child had used
immediately before moving into a seat belt. Most parents indicated that their children were
restrained by a booster seat before being moved into a seat belt (88%), with a small
proportion indicating that their children had been moved from a forward facing child
restraint straight into a seat belt (7%).
Parents were then asked to indicate the age at which their child was moved into a seat belt.
The mean age for children moving into a seat belt was 5.6 years (SD = 1.29 years), with
ages ranging from 3 to 9 years (see Figure 21 for the age distribution).
35
30
Percentage
25
20
15
10
5
0
3
4
5
6
7
8
9
Age (years)
Figure 21 Age distribution for children moving into seat belts.
Parents were asked to list their reasons for moving their child from a forward facing child
restraint/booster seat into a seat belt (see Table 12). Participants were instructed to indicate
as many reasons as appropriate.
40
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
Table 12 Parents’ reasons for moving their child into a seat belt
Reasons
Percentage
My child was too big for the forward facing child restraint /booster 69%
seat
My child disliked sitting in a forward facing child restraint /booster 29%
seat
I needed the forward facing child restraint /booster seat for a younger 12%
child
My child would be more comfortable in a seat belt compared to a 32%
forward facing child restraint /booster seat
My child reached upper end of the weight range recommended by the 35%
forward facing child restraint/booster seat manufacturer
My child would be safer in a seat belt compared to a forward facing 18%
child restraint /booster seat
My child thought that they were too grown up to sit in a forward 27%
facing child restraint/booster seat
My child had their 4th birthday
8%
My child started kindergarten
11%
My child started primary school
11%
Most parents indicated that they had moved their child into a seat belt because their child
was too big for their forward facing child restraint/booster seat (69%).
Parents were then asked to indicate the most important reason for moving their child into a
seat belt (see Table 13).
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
41
Table 13 The most important reason for moving their child into a seat belt
Most important reason
Percentage
My child was too big for the forward facing child restraint/booster seat 45%
My child disliked sitting in a forward facing child restraint/booster 5%
seat
I needed the forward facing child restraint/booster seat for a younger 5%
child
My child would be more comfortable in a seat belt compared to a 9%
forward facing child restraint /booster seat
My child reached upper end of the weight range recommended by the 16%
forward facing child restraint /booster seat manufacturer
My child would be safer in a seat belt compared to a forward facing 9%
child restraint/booster seat
My child thought that they were too grown up to sit in a forward 3%
facing child restraint/booster seat
My child had their 4th birthday
0%
My child started kindergarten
0%
My child started primary school
1%
Other
7%
The most important reasons for moving their child into a seat belt was because their child
was too big for their forward facing child restraint/booster seat (45%) and their child had
reached the upper end of the weight range recommended by the forward facing child
restraint/booster seat manufacturer (16%).
3.4.1
Factors associated with the Appropriate Use of Seat Belts
One of the main aims of this study was to determine the factors that influence appropriate
restraint use in the booster seat age group. The proportion of children appropriately
restrained in seatbelts was extremely low (25%), a finding that precluded multi-variable
logistic regression. The data were analysed using contingency tables. The following factors
were significantly associated with the appropriate use of seat belts:
•
Parents’ Age: As the age of the parent increased, the likelihood of restraining their
child appropriately significantly increased (18-30 years = 3%; 31-40 years = 13%; 41-49
years = 27%; 50 + years = 36%, χ2(3) = 17.03, p ≤ 0.01). However, this finding should be
interpreted with caution since less than 5 percent of the participants were aged 50 years or
older;
42
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
•
Vehicle Type: Participants with smaller vehicles (i.e., 2 door vehicles) were
significantly more likely to appropriately restrain their child (38%) compared to
participants with a 4 door sedan (15%), χ2 (2) = 6.2, p < 0.05;
•
Kilometres driven with children per week: Participants who drove more kilometres
per week with their children (more than 200 km) were significantly more likely to restrain
their child appropriately (29%) compared to participants who drove fewer kilometres per
week (less than 100 km) with their children (18%), χ2 (2) = 7.4, p < 0.05;
•
Parents without a child in a booster seat: Participants without another child
travelling in a booster seat were significantly more likely to restrain their child
appropriately (20%) compared to participants with a child travelling in a booster seat (8%),
χ2 (1) = 7.33, p < 0.01;
•
Child’s Age: Older children were significantly more likely to be restrained
appropriately, in that there was a significant difference in the mean age of children
restrained appropriately (M = 10.16 years, SD = 0.96 years) and inappropriately (M = 7.44
years, SD = 1.12 years), t(388) = 14.15, p < 0.0001. In addition, a univariate logistic
regression model revealed that every 1 year increase in the child’s age was associated with
a 4.21 higher likelihood of being seated appropriately in a seat belt, OR: 4.21, CI: 3.035.84, p<0.0001, and
•
Child’s Weight: Heavier children were significantly more likely to be restrained
appropriately, in that there was a significant difference in the mean weight of children
restrained appropriately (M = 39.84 kg, SD = 8.35 kg years) and inappropriately (M =
26.38 kg, SD = 5.71 kg), t(380) = 15.93, p < 0.0001. In addition, a univariate logistic
regression model revealed that every 1 kilogram increase in the child’s weight was
associated with a 1.32 higher likelihood of being seated appropriately in a seat belt, OR:
1.32, CI: 1.24-1.41, p<0.0001.
Three additional factors were identified as predictors of appropriate use of seatbelts,
however the trends described below did not reach statistical significance:
•
State of Residence: Victorian participants were more likely to restrain their child
appropriately (23%) compared to participants from New South Wales (15%), χ2(1) = 3.28,
p = 0.07;
•
Marital Status: Divorced participants were more likely to restrain their child
appropriately (29%) than married/defacto participants (17%) and single participants (0%),
χ2 (2) = 5.6, p = 0.06. It is important to note however that fewer than 10 percent of parents
were either single or divorced; and
•
Average Trip Length: Participants with higher average trip lengths (more than 10
km) were more likely to appropriately restrain their child (25%) compared to participants
with shorter trip lengths (5-10 km = 17%; less than 5 km = 12%), χ2 (2) = 5.3, p = 0.07.
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
43
4 SUMMARY AND DISCUSSION
The broad aim of this study was to gain a more detailed understanding of the restraint
usage rates, patterns of restraint usage and ‘appropriateness’ of restraint use by children in
the ‘booster seat age’. In addition, another aim of the study was to determine the factors
that influence appropriate restraint use for children in the booster seat age group.
Six hundred and ninety nine parents from the States of New South Wales and Victoria
completed a questionnaire regarding restraint use by their children aged 4 to 11 years. The
questionnaire asked parents to answer questions about their restraint use, their children’s
restraint use, their travel patterns, their motor vehicle crash history, as well as a range of
demographic questions.
4.1
INFORMATION ABOUT PARENTS WHO COMPLETED THE
QUESTIONNAIRE
All parents who participated in the study completed the first section of the questionnaire
which asked them to answer a range of demographic, driving and crash history questions.
The key demographic characteristics of the parents who completed the questionnaire were
as follows:
•
female (88%);
•
aged between 31 to 45 years (82%);
•
married (78%);
•
living in a metropolitan area (36%);
•
living in the State of NSW (70%);
•
earning between $41,000 and $75,000 per year (33%); and
•
had finished a higher degree or technical school/TAFE course (52%).
When the demographic characteristics of the participants were compared to the
demographic characteristics of parents with at least one child under the age of 15 years
reported in the 2001 Australian Bureau of Statistics Census data (2001), the comparison
revealed that parents in the current sample were more likely to be: female; residing in
metropolitan areas and in the State of NSW; and more likely to have completed secondary
school or a university degree.
In addition, analysis of the driving-related characteristics of the sample showed that
parents:
44
•
usually drove their children in a four door sedan (44%);
•
typically drove less than 100 kilometres per week with their children (61%);
•
typically travelled between five and ten kilometres on most trips with their children
(53%);
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
•
drove their children daily or almost daily (81%), and
•
were the person that drove their children the most (88%).
When asked about their motor vehicle crash history in the past two years, only a small
proportion of participants (5%) reported that they had been involved in a motor vehicle
crash where the vehicle had to be towed away. Fifty four percent of the participants who
were crash involved indicated that their children were passengers in the vehicle at the time
of the crash. Finally, most participants indicated that there were ‘no injuries’ sustained in
the crashes (65%), with some participants indicating that at least one passenger sustained
minor or serious injuries (23%, 7%, respectively).
4.2
RESTRAINT USAGE RATES, PATTERNS OF RESTRAINT USAGE AND
‘APPROPRIATENESS’ OF RESTRAINT USE
In the questionnaire, parents were asked about their own and their children’s seating
position and restraint use while travelling in a vehicle. Almost all parents (99%) indicated
that they ‘always’ wore their seat belt while travelling in a vehicle. Similarly, when
participants were asked to indicate how often their children are restrained in their vehicle,
99 percent reported that their children were ‘always’ restrained.
Participants were then asked if there were any circumstances under which they would
allow their child/children to travel while not restrained (either by a booster seat or by a seat
belt). Less than one percent of parents indicated that they would allow their child/children
to travel unrestrained if: travelling at night, their child was asleep, or their child refused to
use the restraint. Less than two percent of parents indicated that they would allow their
child/children to travel unrestrained if: their child’s peers were travelling in the vehicle or
their child was travelling in someone else’s vehicle. Just fewer than four percent of parents
indicated that they would allow their child/children to travel unrestrained if there were not
enough restraints for all passengers.
When asked to indicate the type of restraint that their children travelled in, only 24 percent
of children aged between 4 to 11 year olds were travelling in a booster seat, while the
remaining 76 percent were travelling in a seat belt. The large proportion of children aged 4
to 11 years travelling in a seat belt is consistent with the findings from several international
observational studies that have reported high proportions of seat belt wearing rates (i.e., up
to 75%) in the booster seat age group (Decina & Knoebel, 1997; Ramsey et al., 2000).
Not surprisingly, children travelling in booster seats were significantly younger, lighter (in
terms of their weight) and shorter (in terms of their height) than children travelling in a seat
belt. This is consistent with the findings reported by Durbin et al. (2003) who reported that
child restraint use is generally higher for younger children. However what was surprising
was that children travelling in a booster seat were significantly more likely to be sitting in
the front passenger position (for all vehicle types) (38%) compared to children travelling in
a seat belt (28%).
When asked whether there were circumstances under which their children’s seating
positions changed from its typical position, most parents indicated children’s seating
positions typically changed when other children were travelling in the vehicle (38%) or
when another adult was travelling in the vehicle (29%). In both of these scenarios, parents
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
45
indicated that children who typically travelled in the front seat generally moved into the
rear seat to sit with their peers or to give the front seat to the adult.
An important aim of this study was to determine if children aged between 4 and 11 years of
age were being appropriately restrained while travelling in their vehicle. While there is no
current Australian legislation regarding the appropriateness of restraints for older children,
there are a number of Australian-based guidelines and international recommendations and
legislation indicating appropriateness of restraint use based on approximate age, weight
and/or height measures. While there is some small variation in these guidelines, for the
purposes of this study, the criterion selected was a relatively conservative measure:
Children were appropriately restrained in a booster seat if their height was more than 100
centimetres and less than or equal to 140 centimetres, while children travelling in a seat
belt were appropriately restrained if their height was more than 140 centimetres (i.e.,
NHTSA, 2001). The children’s height, rather than their age or weight, was used to assess
appropriateness because their height governs the positioning of the lap/shoulder seat belt
across the child’s shoulders and hips. Based on the height measurements provided by
parents, children travelling in a booster seat were significantly more likely to be
appropriately restrained (93%) compared to children travelling in a seat belt (25%). That is,
according to the current guidelines, 75 percent of children in the current sample are too
short to be properly restrained by the seat belt.
When restraint appropriateness was investigated across the age range, children at the lower
(4 year olds) and upper (i.e., 11 & 10 year olds) ends of the age group were most likely to
be restrained appropriately, whereas children in the middle of the age range (i.e., 7 and 8
year olds) were least likely to be restrained appropriately, and are therefore at the greatest
risk of injury if involved in a motor vehicle crash.
In addition as outlined earlier, children travelling in a booster seat were significantly more
likely to be sitting in the front passenger position in their vehicle compared to children
travelling in a seat belt. Previous research conducted by Braver et al. (1998), Berg et al.
(2000) and Brown et al. (2005) has reported that children travelling in the front seat are
significantly more likely to sustain an injury while sitting in the front seat compared to if
they were travelling in a rear seat. Consequently, a second measure of children’s ‘restraint
appropriateness’ was calculated, incorporating seating position. That is, children were only
considered to be travelling appropriately if their height met the current Australian restraint
guidelines and they were not traveling in the front seat (for both booster seats and seat
belts). Once seating position was taken into account, the proportion of children travelling
appropriately in a booster seat decreased from 93 percent to 51 percent. Similarly, the
proportion of children travelling appropriately in a seat belt decreased from 25 percent to
15 percent, once seating position had been taken into account.
These findings are consistent with a number of previous studies that have reported that a
relatively high proportion of children are commonly ‘graduated’ to seat belts too early.
That is, children who grow out of a CRS suitable for young children move directly into a
seat belt rather than using a booster seat (Ramsey et al., 2000; Winston et al., 2000). One
explanation for the premature graduation to seat belts could be that parents are confused
about the appropriate thresholds for transition from a forward facing child restraint to a
booster seat as well as the transition from a booster seat to a seat belt (Rivara et al., 2001).
The underlying explanations for the inappropriate use of adult restraints, particularly by the
“booster seat age group” is likely to be complex and is explored in more detail in the next
section.
46
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
4.2.1
Children’s Use of Booster Seats
Children’s use of booster seats was examined using the responses from 243 parents with a
child aged 4 to 11 years, currently restrained in their vehicle by a booster seat.
Firstly, parents were asked to provide the age, gender, weight and height for the child who
had most recently moved into a booster seat:
•
The mean age for children travelling in a booster seat was 5.37 years (SD = 1.27
years), with children’s ages ranging from 1.58 to 10.33 years.
•
There were approximately equal proportions of male and female children (46%,
56%, respectively).
•
The mean weight was 20.31 kilograms (SD = 4.05kgs), with the children’s weights
ranging from 12 to 35 kilograms.
•
The mean height was 111.83 centimetres (SD = 12.90cm), with the children’s
heights ranging from 48 to 156 cm.
Based on the height measurements provided by parents, 85 percent of children were
appropriately restrained in a booster seat according to the current restraint guidelines (i.e.,
their height was more than 100 centimetres and less than or equal to 140 centimetres).
Parents were asked to indicate how often their child was restrained while travelling in a
vehicle. The majority of parents reported that their child was ‘always’ restrained in their
booster seat (78%). When asked if there were any circumstances under which they would
allow their child to travel in a vehicle without a booster seat (i.e., in a seat belt), most
parents indicated that it would be if their child was travelling in someone else’s vehicle
(42%) or when they were travelling on short trips (24%).
Parents were asked to indicate what their child liked and disliked about travelling in their
booster seat. The most popular reason provided by parents was that their child liked being
elevated by the booster seat, and therefore had better visibility out of the window (71%).
Other responses included that the children found the booster seat more comfortable/felt
better restrained (12%) and that the children could rest their head on the booster seat wings
when sleeping (7%). Since these are factors that appeal to children, it is likely that they
could be influential in promotion of booster seat use amongst children. On the other hand,
the most popular reason provided by parents was that their child disliked the fact that they
couldn’t buckle/unbuckle themselves in their booster seat (33%). In addition, some
children felt it was unfair that they had to travel in a booster seat when siblings or friends
did not have to (22%), that they found the booster seat uncomfortable (22%) or that they
were too big/mature/grown up to travel in a booster seat (20%). This finding is consistent
with previous research conducted by Rivara et al. (2001) and Winston et al. (2004) which
showed that one of the main barriers towards the use of booster seats was the “young
child’s desire to act grown up and not to have to sit in any type of restraint”.
When asked about their child’s booster seat, most participants indicated that they had
purchased the booster seat new (77%). However, only 51 percent of parents appeared to
regard the purchase of the booster seat as an important task that merited doing at least
some homework. In addition, fairly ‘low engagement’ methods of obtaining information
predominated, for example from the shop where they purchased the booster seat (75%).
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
47
When asked to indicate the factors that were important to them when choosing which
booster seat to purchase, most participants reported that it was important to purchase a seat
that met with Australian standards (94%) and that was comfortable (84%).
In order to investigate the factors that are involved in the decision making process about
when to move their child from a forward facing child restraint to a booster seat,
participants were asked to indicate the reasons why they had moved their child into a
booster seat. Most parents indicated that they had moved their child into a booster seat
because their child was too big for the forward facing child restraint (72%) and their child
would be safer in a booster seat compared to a seat belt (64%). In addition, most
participants indicated that the most important reason for moving their child into a booster
seat was because their child was too big for their forward facing child restraint (34%).
Participants were then asked about their child’s transition from a booster seat to a seat belt.
More specifically, participants were asked to indicate how they would know when to move
their child into a seat belt. Most participants indicated that they would move their child into
a seat belt when their child reached the upper end of the weight range recommended by the
child seat manufacturer (75%). Fewer parents of children currently using booster seats
(47%) indicated that they would rely on height-based criteria (such as the position of
child’s eyes in relation to the top of the vehicle seat or headrest). This suggests that there
needs to be a greater public awareness of the importance of height-based measures and
goodness of fit of the seat belt to assist parents in knowing when their child should make
the transition from boosters to seat belts.
4.2.1.1 Factors associated with the Appropriate Use of Booster Seats
One of the main aims of this study was to explore the factors that are associated the
appropriate use of a booster seat. In order to investigate these factors, a multivariate
logistic regression model was performed which revealed a number of key predictors of
appropriate booster seat use. These are discussed below.
The first three key predictors related to the child. The child’s age and weight were
observed to be associated with being seated appropriately in a booster seat in the vehicle.
This finding is not surprising given that ‘appropriateness’ of booster seat use was
determined by using the child’s height and that children typically grow taller as they get
older. In addition, female children were more than three times more likely to be seated
appropriately than male children. It is important to note that there was no significant
difference in terms of height and weight for females and males. One explanation could be
that female children may be more compliant in terms of being restrained in a booster seat,
however this needs to be explored in future research.
The next three key predictors related to the parents. First, parents in the highest income
bracket were more likely to seat their child appropriately than those in the lowest income
bracket, although there was no difference for those in the middle-income bracket. This
finding is consistent with previous research that showed a positive relationship between
driver socioeconomic status (education and income) and frequency of CRS use (Wagenaar
et al., 1988; Russell et al., 1994). Secondly, parents driving longer distances were more
likely to seat their child appropriately than parents driving shorter distances. One possible
explanation for this finding could be that parents who drive with their children more may
be aware that they are increasing their children’s driving exposure, and therefore crash risk,
and therefore appropriate restraint may be more important to them. Thirdly, parents who
answered ‘false’ to the statement “I will know to move my child from a booster seat to a
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MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
seat belt when my child’s eyes are level with the top of the seat or headrest” were over
four times more likely to use the booster appropriately, compared to parents who answered
‘true’. In addition, parents who answered ‘don’t know’ were nine times more likely to use
the booster appropriately than those answering ‘true’. One explanation for this finding
could be that the parents answering ‘false’ or ‘don’t know’ were following the booster seat
manufacturer’s instructions for the upper limit of the booster seat manufacturer’s
recommendations.
The final key predictor related to the restraint use of other children in the vehicle. Parents
with another child in a seat belt were almost eight times more likely to be using a booster
seat appropriately compared to parents without a child in a seat belt, a result that could be
indicative of more experience in using booster seats for the older child.
4.2.2
Children’s Use of Seat Belts
Children’s use of seat belts was examined using the responses from 514 parents with a
child aged 4 to 11 years, currently restrained in their vehicle by a seat belt.
Firstly, parents were asked to provide the age, gender, weight and height for the child who
had most recently moved into a seat belt:
•
The mean age for children travelling in a seat belt was 7.83 years (SD = 1.77
years), with children’s’ ages ranging from 3.5 to 11.42 years.
•
There were equal proportions of male and female children (50% for each group).
•
The mean weight was 28.57 kilograms (SD = 8.04 kg), with the children’s weights
ranging from 12 to 70 kilograms.
•
The mean height was 127.94 centimetres (SD = 14.75 cm), with the children’s
heights ranging from 45 to 170 cm.
A simple calculation was performed to determine if children were being appropriately
restrained in a seat belt. Based on the height measurements provided by parents, 83 percent
of children were not being appropriately restrained according to the selected height criteria
(i.e., they were not over 140cm).
When asked to indicate the type of restraint that their child had used immediately before
moving into a seat belt, most parents indicated that their child had moved from a booster
seat (88%), with a small proportion indicating that their child had been moved from a
forward facing child restraint (7%). This finding indicates that the majority of parents are
aware of the continued use of child restraint use beyond the toddler age group. However,
the lack of definitive legislation regarding ‘appropriate’ restraints for older children
appears to contribute to some level of confusion about when children should be moved into
a seat belt. This may in turn contribute to the apparent widespread practice of premature
graduation of children into seat belts, placing them at an unnecessarily higher risk of
serious injury.
Parents were then asked to indicate the age at which their child was moved into a seat belt.
The mean age for children moving into a seat belt was 5.62 years (SD = 1.29 years), with
ages ranging from 3 to 9 years.
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
49
Parents were asked to list the reasons that they had moved their child from a forward
facing child restraint/booster seat into a seat belt. Most parents indicated that they moved
their child into a seat belt because their child was too big for their forward facing child
restraint/booster seat (69%), their child was old enough not to slide out of the seat belt
unaided (38%) or that their child would be more comfortable in a seat belt compared to a
forward facing child restraint/booster seat (32%).
4.2.2.1 Factors associated with the appropriate use of seat belts
A number of factors were found to be associated with appropriate seat belt use. Consistent
with the findings for appropriate booster seat use, the child’s age and weight were observed
to be positively associated with being appropriately restrained in a seat belt. Three other
key predictors of appropriate seat belt use were related to the parents and their driving
patterns. Firstly, parents with smaller vehicles (i.e., 2 door vehicles) were significantly
more likely to appropriately restrain their child compared to participants driving a 4 door
sedan. Secondly, consistent with the relationship observed between trip length and
appropriateness of booster seat, parents driving more kilometers per week with their
children in the vehicle were significantly more likely to restrain their child appropriately
compared to participants driving fewer kilometers per week. As outlined earlier, one
possible explanation for this finding could be that parents who drive with their children
more may be aware that they are increasing their children’s driving exposure, and therefore
crash risk, and therefore appropriate restraint may be more important to them. Thirdly, as
the age of the parent increased, the likelihood of restraining their child appropriately
increased. Reasons for this finding are not clear, however, one possible explanation is that
older parents may make more appropriate restraint choices because they have had more
exposure to information about correct restraint use, possibly through experience with older
children in their family. Finally, appropriate seat belt use was also found to be related to
use of other booster seats in the vehicle. Parents without another child travelling in a
booster seat in their vehicle were significantly more likely to restrain their child
appropriately compared to participants with a child travelling in a booster seat. One
explanation for this finding could be that parents with a younger child travelling in a
booster seat in their vehicle may have had to move their older child prematurely into a seat
belt to make room for the younger child.
4.3
LIMITATIONS
There are some limitations of this study that warrant some discussion. Firstly, the
‘appropriateness’ of restraint use was calculated using the height measurements provided
by parents in the questionnaire. Although parents were encouraged to provide their child’s
current height measurement, it is not possible to determine if the provided measurements
were current and/or accurate.
In addition, some children may have been moved into a seat belt because they exceeded the
weight range recommended by the booster seat manufacturer (rather than their height), and
therefore for the purpose of the current study would be deemed ‘inappropriate’. However,
given that it is the children’s height, rather than their age or weight, that governs the
positioning of the lap/shoulder seat belt across the child’s torso and hips, height was
chosen to calculate restraint appropriateness (NHTSA, 2001).
Although the current recruitment procedure endeavoured to ensure representativeness of
participants on the basis of geographic location (i.e., recruited participants from both urban
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MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
and rural areas in both States), parents in the current sample were more likely to be
residing in metropolitan areas and in the State of NSW, as well as being more likely to
female and to have completed secondary school or a university degree compared to the
data provided by parents in the 2001 Australian Census. However, it should be noted that
the sample was relatively representative of the population on the remaining variables,
including age, marital status and household income. While the current sample of
participants is perhaps less representatative of the population, this limitation is an inherent
problem of surveys of this kind.
The results demonstrated a high rate of parents who always wear a seatbelt (99%) and
always restrain their children (99%). The vigilance of the participants in this survey is
greater than that shown by crash data, where 10 percent of children who were injured or
killed were not restrained and in 30 percent of cases, the victim’s restraint status was
unknown. This difference may be the result of a “volunteer bias,” in that those individuals
who agreed to participate in the study are systematically more vigilant about seatbelt
and/or booster seat usage than non-participants. Alternatively, the difference could also be
the result of a “reporting bias” Previous research involving self-reports of socially
unacceptable behaviours, such as smoking, has shown that some participants tend to deny
engaging in socially unacceptable behaviours in research settings (Suadicani, Hein &
Gyntelberg, 1997). A similar effect may have occurred in these results; however, it is
expected that the anonymity of surveys would have helped to control for it.
Notwithstanding these limitations, the study has provided some interesting and valuable
information on which to base countermeasures and further research.
5 CONCLUSIONS AND RECOMMENDATIONS
5.1
CONCLUSIONS
The results of this study revealed that only 24 percent of children in the ‘booster seat age
range’ (i.e., 4 to 11 years) were travelling in a booster seat, with the remaining children
travelling in a seat belt. The findings from this study also showed that children travelling in
a booster seat were significantly more likely to be appropriately restrained (93%)
compared to children travelling in a seat belt (25%).
One of the surprising findings from this study was that children travelling in a booster seat
were significantly more likely to be sitting in the front passenger position in their vehicle
compared to children travelling in a seat belt. Consequently, once seating position was
taken into account, the proportion of children travelling appropriately decreased from 93
percent to 51 percent for booster seats and 25 percent to 15 percent for seat belts.
It was interesting to note that most parents of children currently restrained by a seat belt
indicated that their children had moved into the seat belt from a booster seat (88%). This
finding indicates that the majority of parents have good intentions regarding the
appropriate restraint of their children. However, the lack of definitive legislation regarding
‘appropriate’ restraints for older children appears to be resulting in confusion about when
children should be moved into a seat belt and therefore parents are prematurely graduating
their children into seat belts and placing them at an unnecessarily higher risk of serious
injury.
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
51
This study has provided a rich source of information regarding restraint usage rates,
patterns of restraint usage and ‘appropriateness’ of restraint use by children in the ‘booster
seat age’, as well as the attitudes of parents of children in the booster seat age group
towards restraint wearing behaviour. Based on the findings of this study, a number of
recommendations are made for strategies to enhance appropriate restraint use for the
booster seat age group as well as future research.
5.1.1
Recommendations for promoting booster seat use
Based on the findings from this study, a key recommendation is the need for more
definitive Australian legislation pertaining to child restraint use for older children. As
outlined earlier, such legislation has the potential to have a dramatic positive effect on
children’s restraint wearing rates (Winston et al., 2004), presumably because it reduces
parents’ confusion about when to move their child from a forward facing child restraint
into a booster seat and from a booster seat in to a seat belt.
In addition, guidelines provided by the child restraint manufacturers should include the
upper end of the height range, rather than just the upper end of the weight range, since
height, particularly seated height, plays a significant role in determining the correct
alignment of the seat belt on the child’s pelvis and shoulder. This correct alignment is
critical in reducing the potential for abdominal and neck injuries resulting from motor
vehicle crashes.
Another strong recommendation emerging from this study is the need for development of
improved educational and awareness materials and programs for both parents and children
to enhance appropriate restraint use for the booster seat age group.
Such material should include the following information:
o The safety benefits associated with CRS use, particularly the benefits
associated with booster seat use;
o Injury risks associated with the premature graduation into seat belts;
o Information regarding appropriate transition (especially highlighting the
importance of using their children’s height as an indicator rather than their
age or weight) from:
forward facing child restraints to a booster seats
booster seats to seat belts;
o Safety benefits associated with rear seat positioning; and,
o Tips for parents to encourage their child/children to remain restrained in the
appropriate restraint type until they meet the height requirements for the
next restraint type.
In addition, the distribution of this information is critical. The results of this study showed
that parents primarily seek information at the point of purchase of restraint systems.
However, little is known about the quality and nature of the information distributed at
those sources. Clearly it will be important to explore how clear and effective safety
messages can be distributed to both parents and children.
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MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
Current information on CRS available in Australia appears to be primarily directed towards
parents. However, to maximise the effectiveness of this road safety message, it will be
critical that children are also involved as active participants in road safety awareness
campaigns. The EUCHIRES campaign, which has been adopted across a number of
European countries, provides a useful model for a child-centred safety message on booster
seat use.
5.1.2
Recommendations for further research
This study has provided detailed information regarding restraint usage rates, patterns of
restraint usage and ‘appropriateness’ of restraint use, however there is still much to be
learned about the factors that are associated with ‘appropriate’ restraint use by older
children in the ‘booster seat age’ group. For example, while the current study has provided
some information about the influence of parent’s demographic information, attitudes
towards road safety and restraint wearing behaviour on their child’s restraint use, the study
has not explored the influence of children’s attitudes towards restraint use. This may be
important since children at this age are beginning to develop more mature decision making
processes and forming their own set of attitudes and beliefs that could influence their
restraint wearing behaviour. Such research may be able to identify potential barriers to
restraint use in the booster seat age group, and therefore potential strategies to overcome
inappropriate use.
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
53
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Arbogast, K., Kallan, M. & Durbin, D. (2005). Effectiveness of high back and backless
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Australian Transport Safety Bureau (2004a). Road Safety Statistics Report. Serious Injury
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Durbin, D. (2001). Booster seat use and effectiveness in crashes. Booster Seats for
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Durbin, D., Chen, I., Smith, R., Elliott, M.R. &Winston, F. (2005). Effects of Seating
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Maltese, M., Chen, I. & Arbogast, K. (2005). Effect of increased rear row occupancy on
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FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
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7 APPENDICES
Appendix 1: Letter of Invitation to Principals
February 2005
Dear Principal,
The Monash University Accident Research Centre is carrying out a project for the
Motor Accident Authority (MAA) to examine the attitudes of parents regarding the
use of child seats by children of pre-school and primary school age. Child restraint
systems for vehicles are designed to provide specialist protection for child
occupants of vehicles in the event of a crash. Australian legislation specifies the
use of a dedicated child restraint for infants up to one year old; however, for older
children, the legislation is less definitive, stating only that an ‘appropriate’ restraint
(dedicated child restraint or seat belt) should be used. Hence, the responsibility
largely rests upon parents to determine what restraint is ‘appropriate’ for older
children.
At the conclusion of this study, it is anticipated that we will have a better
understanding of the underlying explanations why children are prematurely moved
to adult restraints, and why some children continue to ride unrestrained.
A desired outcome of this study will be the provision of critical information for road
safety authorities as well as the general community for raising parents’ awareness
of the safety benefits of: correct use of child restraints; child/child restraint
compatibility; children being restrained at all times. Outcomes will be documented
in a report for the funding body as well as a publication to be presented at a
national or international road safety conference forum and a relevant scientific
journal. The expected outcomes will potentially reduce the number and severity of
injuries sustained by child passengers involved in crashes.
Who is conducting this research?
The Monash University Accident Research Centre (MUARC) is the largest multidisciplinary research institute for accident and injury prevention research in
Australia. The research at MUARC spans all forms of injury and injury prevention –
road safety, occupational safety, sporting and recreational safety and domestic
safety. The Centre has developed a strong national and international reputation for
provision of high quality research and policy development that contribute to
reducing the burden of injury. The research team consists of Dr Judith Charlton,
Professor Brian Fildes and Dr Sjaanie Koppel who have extensive experience in
research in road safety including a substantial research program on vehicle
occupant protection including child passenger safety.
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MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
Who is being invited to participate in this research?
With the approval to approach schools of the department, we would like to extend
an invitation to the parents/guardians of children attending your primary school to
participate in this research. We are specifically recruiting individuals who:
•
Have a valid driver’s licence, and
•
Have a child or children aged between 4 to 11 years of age.
What is involved?
If you agree to participate in this project, we will send you ‘questionnaire packs’
that we would ask you to send home to every student’s household. This pack has
been attached for your perusal. The ‘questionnaire pack’ includes:
•
•
•
A letter of invitation;
A questionnaire, and
An expression of Interest form.
The letter of invitation outlines the general aims of the study and invites
parents/guardians to participate in the study. The questionnaire includes questions
regarding the use of dedicated child restraint systems; the factors influencing their
choice of restraint type; their child’s/children’s seating position in their vehicle; their
child’s/children’s height and weight; what their child/children like/dislike about their
current restraint system; their general knowledge regarding child restraint systems,
their prior involvement in motor vehicle crashes in the last two years and general
injury outcomes resulting from these crashes and some general demographic
questions (e.g., age, gender, number of kilometres driven per week).
The questionnaire will take approximately 25 to 30 minutes to complete. If the
parents/guardians would like to participate in this project, we will ask them to
complete the questionnaire and post it back to us using a reply-paid envelope that
we will provide.
We are planning on investigating other aspects of child restraint safety in the
future. If parents would like to take part in other research projects being conducted
by MUARC, we will ask them to complete the details in the Expression of Interest
form and return it to our research team using an additional reply-paid envelope. A
member of our research team will contact the parent at a convenient time via
telephone and provide them with more information about the future research
projects. If parents fill out this form, they are not obligated to participate in future
projects.
Confidentiality
The information we will collect is for research purposes only and will be treated in
the strictest confidence. No identifying information will be reported or published.
Only members directly involved in the research will have access to the data, which
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
59
will be stored securely for a minimum period of seven years in accordance with
Monash University regulations.
Findings
It will not be possible to inform parents of the outcomes of the study on an
individual basis. However, at the conclusion of the study, participants may obtain
group findings from Monash University Accident Research Centre website. The
findings will be made available to the sponsors of the project (MAA) in the form of
a report and conference papers and journal articles may also arise from this
research project.
Contacts
If you have any queries or would like to be informed of the findings of the study,
please contact
Dr Judith Charlton at Monash University.
Tel: (03) 9905 1903
Fax: (03) 9905 4363
E-mail: [email protected]
Post: Dr Judith Charlton
Accident Research Centre,
Building 70,
Monash University,
VIC 3800.
Research Team Leaders
Dr Judith Charlton - Chief Investigator
Dr Sjaanie Koppel – Co-Investigator
Professor Brian Fildes- Co-Investigator
Should you have any complaint concerning the manner in which this research is conducted,
please do not hesitate to contact The Standing Committee on Ethics in Research on Humans at
the following address:
The Secretary
The Standing Committee on Ethics in Research on Humans
P.O. Box 3A, Monash University, Victoria 3800
Telephone: (03) 9905 2052
60
Fax: (03) 9905 1420
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
Appendix 2: Parental Letter of Invitation
Child Passenger Safety:
Children’s use of seat belts and booster seats
Letter of Invitation/Explanatory Statement
June 2005
Dear Parent/Guardian,
Child restraint systems for vehicles are designed to provide specialist protection
for child occupants of vehicles in the event of a crash. Australian legislation
requires that for children older than one year, an ‘appropriate’ restraint (dedicated
child restraint or seat belt) should be used. Hence, the responsibility largely rests
upon parents to determine what restraint is ‘appropriate’ for older children.
The Monash University Accident Research Centre is carrying out a project for the
Motor Accident Authority (MAA) to examine the attitudes of parents towards their
children’s restraint-wearing behaviour. In particular, the study aims to investigate
the use of boosters and seat belts by children aged 4 to 11 years and how parents
decide which restraints are appropriate for their child.
At the conclusion of this study, it is anticipated that we will have a better
understanding of factors that influence parents’ decision-making about
whether/how their children are restrained when travelling as passengers in motor
vehicles.
Who is invited to participate in this research?
With the approval of the Department of Education and Training, your primary
school has been selected to participate in this research. We extend an invitation to
parents/guardians who:
•
Have a valid driver’s licence,
•
Have a child or children aged between 4 to 11 years of age.
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
61
What is involved?
If you agree to take part in the project, you will be asked to complete a
questionnaire that is attached.
The questionnaire will ask questions about: whether your child/children use a
dedicated Child Restraint System, the factors influencing the choice of restraint
type; your child’s/children’s seating position in your vehicle; your child’s/children’s
height and weight; what your child/children like/dislike about their current restraint
system; your general knowledge regarding child restraint systems, your prior
involvement in motor vehicle crashes in the last two years and general injury
outcomes resulting from these crashes and some general questions about yourself
(e.g., your age, gender, number of kilometres you drive per week).
The questionnaire will take approximately 25 to 30 minutes to complete. You do
not have to answer any question or section of the questionnaire if you do not feel
comfortable doing so. If you would like to participate in this research, please
complete the questionnaire and post it back to us using the reply paid envelope
provided.
We are planning on investigating other aspects of child restraint safety in the
future. If you would like to take part in other research projects being conducted by
MUARC, please complete the details in the Expression of Interest form and return
it to our research team using the smaller reply paid envelope. A member of our
research team will contact you at a convenient time via telephone and provide you
with more information about the future research projects. If you fill out this form,
you are not obligated to participate in future projects.
Confidentiality
The information we will collect is for research purposes only and will be treated in
the strictest confidence. No identifying information will be reported or published.
Only members directly involved in the research will have access to the data, which
will be stored securely for a minimum period of seven years in accordance with
Monash University regulations.
Findings
It will not be possible to inform you of the outcomes of the study on an individual
basis. However, at the conclusion of the study, you may obtain group findings from
Monash University Accident Research Centre website. The findings will be made
available to the sponsors of the project (MAA) in the form of a report and
conference papers and journal articles may also arise from this research project.
62
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
Contacts
If you have any queries or would like to be informed of the findings of the study,
please contact Dr Judith Charlton at Monash University.
Tel: (03) 9905 1903
Fax: (03) 9905 4363
E-mail: [email protected]
Post: Dr Judith Charlton
Accident Research Centre,
Building 70,
Monash University,
VIC 3800.
Research Team Leaders
Dr Judith Charlton - Chief Investigator
Dr Sjaanie Koppel – Co-Investigator
Professor Brian Fildes- Co-Investigator
Should you have any complaint concerning the manner in which this research is conducted, please do
not hesitate to contact The Standing Committee on Ethics in Research on Humans at the following
address:
The Secretary
The Standing Committee on Ethics in Research on Humans
P.O. Box 3A, Monash University, Victoria 3800
Telephone: (03) 9905 2052
Fax: (03) 9905 1420
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
63
Appendix 3: Questionnaire
Child Passenger Safety:
Children’s use of seat belts and booster seats
Please fill out this questionnaire if you have a child or children aged between 4 and
11 years of age.
Section A: Demographic Information
This section asks some questions about you and your driving habits. Please tick
the box that best describes you.
A.1
What is your age? (Tick One)



18 - 25 years

36 - 40 years

50 years and over
A.2
Are you: (Tick One)

Male?
A.3
What is your place of residence? (Tick One)


Metropolitan area 
Regional city
Rural area (i.e., not in a country town)
A.4
What State of Australia do you live in? (Tick One)

New South Wales
A.5
What is your current marital status? (Tick One)



Single

Divorced

Other (please specify)
26 - 30 years
41 - 45 years




31 - 35 years
46 - 49 years
Female?

Country town
Victoria
De facto
Separated


Married
Widowed
_________________________________________________________________
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MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
A.6
Is English your first language? (Tick One)

Yes
A.7
What is your household income before tax? (Tick One)


Less than $20,000 
$76,000-$100,000 
A.8
What is the highest level of education you have completed?

No
$20,000-$40,000 
More than $100,000
$41,000–$75,000
(Tick One)







Primary school
Intermediate (Year 10)
VCE/HSC
Technical school or TAFE (including trade certificate/ apprenticeship)
Degree from University, College of Advanced Education
Higher Degree
Other (please specify)
_________________________________________________________________
A.9
What type of car do you usually drive in with your children?
(Tick One)



2 door sedan

4 door hatchback 
People mover/Van 
4 door sedan

Station wagon

Other (please specify)
2 door hatchback
4WD
_________________________________________________________________
A.10 What is the make and model of this vehicle?
Make _____________________
Model _______________________
A.11 How many kilometres do you drive with your children per
week? (Tick One)


Less than 100 km
More than 501 km

101-200 km

201-500 km
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
65
A.12 Would you say that most of your trips are:


More than 10 km
Between 3 and 5 km


Between 5 and 10km
Less than 3 km
A.13 How often do you drive with your children? (Tick One)


Daily or almost daily
Once a week


Two or three times a week
Once a month or less
A.14 Who drives your children most frequently? (Tick One)



Yourself

Your partner/husband/wife
Grandparent

Your friend/neighbour
Other (please specify)
_________________________________________________________________
66
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
Restraint Use
This section asks some questions about how your family typically travels in your
car – including any children younger and/or older than the 4 to 11 year age range
of interest.
A.15 What type of restraints do your children currently use?
(Please state the age, gender, weight*, height* and type of restraint for each child in your
household).
Age (years & months)
Gender (male/female)
Weight (kg) - Please
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
M
M
M
M
M
M
F
F
F
F
F
F
weigh your child and
record here
Height (cm) - Please
measure your child and
record here
Type of restraint:
Infant capsule
Convertible (Rear-facing
for infant)
Forward-facing child seat
Booster seat (with high
back)
Booster cushion (without
a back support)
Seat belt - Lap/sash
Seat belt - Lap only
* It is important that the measures of your children’s height and weight are current.
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
67
A.16 Please indicate on the diagram of the vehicle where your
children typically sit when travelling in the vehicle
(For example if the
child described as “Child 1” in the above Table typically sits in the left rear seat of your car,
please write number 1 in the left rear box on the car. If “Child 4” sits in the third row of your
station wagon, please write number 4 in the third row box on the station wagon. If you have
a different type of vehicle see A.17).
Car
Station Wagon
Van/People
Mover
A.17 If the vehicles above do not reflect the seating pattern in
your vehicle (i.e., if you typically drive a utility), please describe
your children’s typical seating arrangements below.
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
68
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
THE FOLLOWING QUESTIONS APPLY TO YOUR
CHILD/CHILDREN IN THE 4 TO 11 YEAR AGE RANGE
ONLY.
A.18 Sometimes children’s seating positions may differ from their
typical position. Please indicate which of the following reasons
apply to your child/children (Tick as many as applicable).
Do the seating positions No
change:
When there is more than one
adult travelling in the vehicle?
When travelling on long trips?
When travelling on short
trips?
When you have other
people’s children travelling in
your vehicle?
Other (please specify):
If YES, please describe how and why the
seating positions change.
A.19 How often do you wear your seat belt while travelling in a
vehicle?
 Always
 Mostly
 Sometimes
 Never
 Not sure
A.20 How often are your children restrained while travelling in a
vehicle?
 Always
 Mostly
 Sometimes
 Never
 Not sure
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
69
A.21 Are there any circumstances under which you would allow
your child/children to travel while not using either a seat belt or a
child seat/booster? (Tick as many as applicable)
Reasons for non-restraint
While travelling at night
If my child is asleep
If my child refuses to use the restraint
If my child’s peers are travelling in the vehicle
On short trips
If my child is travelling in someone else’s vehicle
If there are not enough restraints for all passengers
Other (please specify):
70
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
Yes
No
Child Restraints – True or False
A.22 The following table contains a list of statements about child
restraints. Please read each of the statements and indicate
whether you think that they are true or false. If you are not sure,
please tick the “don’t know” column*.
True
1
2
3
4
5
6
7
8
9
10
11
False
Don’t
Know
Legally, children of any age can sit in the front seat of a car if
they are wearing a seat belt
Children under the age of 8 years should not sit in the front
seat of a car
Babies must travel in a specially fitted capsule
If the car is in a major accident, the child restraint should be
replaced and the old ones thrown away
If the car is in a minor accident, the child restraint should be
replaced and the old ones thrown away
Children can sit in the back of a car with only a seat belt once
their eyes are level with the head rest of the seat in front of
them
The correct time for a child to move from a child seat to a
booster is when they are 4 years old
If I am giving someone else’s child a lift, their parents are
responsible for restraining them in my car
Crash tests show that some types and makes of child
restraints are safer than others even if they meet the
Australian Standard
The main benefit of boosters is to lift children to a sitting
height so that the seat belt is positioned properly
There are laws in my State against travelling with
unrestrained passengers
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
71
Motor Vehicle Crashes
A.23 Thinking back over the last two years, have you been
involved in a motor vehicle crash, in which any of the vehicles
involved had to be towed away? (Tick One)

Yes

No
A.24 Were any of your children passengers in the car at the time
of the motor vehicle crash?

Yes

No

Not applicable
A.25 Did the crash result in: (Tick as many as applicable)




No injuries to any occupants in your motor vehicle
Minor injuries (i.e., not hospitalised) to you or someone else in the car
Serious injuries (i.e., hospitalised) to you or someone else in the car
Not applicable
Please complete Section B of this questionnaire if you have a
child or children aged 4 to 11 years who travel in a booster seat.
AND/OR
Please complete Section C of this questionnaire if you have a
child or children aged 4 to 11 years who travel in a seat belt.
72
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
Section B: Children’s use of booster seats
Please fill out this section only if one or more of your children aged 4 to
11 years travels in a booster seat. If you have more than one child
aged between 4 and 11 years in your household, please answer the
following section with regard to the child who has most recently moved
into a booster seat.
B.1
Please list the age, gender, weight and height for your child
who has most recently moved into a booster seat.
Age:
_____ years _____ months
Gender:

Weight:
______ kilograms
Height:
______ centimetres
B.2
Male 
Female
How often is your child restrained in a booster seat while
travelling in a vehicle?
 Always
 Mostly
 Sometimes
 Never
 Not sure
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
73
B.3
Are there any circumstances under which you would allow
your child to travel in a vehicle without a booster seat (just in a
seat belt)? (Tick as many as applicable)
Reasons for not travelling in a booster seat
While travelling at night
If my child is asleep
If my child refuses to use the restraint
If my child’s peers are travelling in the vehicle
On short trips
If my child is travelling in someone else’s vehicle
If there are not enough restraints for all passengers
Other (please specify):
B.4
Yes
No
What does your child like about travelling in their booster
seat?
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
B.5
What does your child dislike about travelling in their booster
seat?
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
B.6
How did you acquire the booster seat?



Purchased it new

Borrowed/Given by friend/family 
Other (please specify)
Purchased it second hand
Rented
_________________________________________________________________
74
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
B.7
If you purchased the booster seat, did you obtain any
information
about
the
booster
seat
you
selected
before

Not applicable
purchasing it? (Tick one)

Yes
B.8
If

yes,
–
Please
No
indicate
where
you
obtained
the
information? (Tick as many as appropriate).
Information source
B.8
Tick where you
obtained
information
B.9
Tick the most
useful (Tick
one)
Maternal and Child Health Centres
Newspapers/Magazines/Brochure/Books
School/Kinder/Playgroup
Word of mouth (family, friend)
RTA/RACV/NRMA Buyers guide
VicRoads/RTA website/brochure
Autoclub website/brochure
Shop where you purchased the restraint
Other (please specify)
------------------------------------------------------
B.9
What source in B.8 did you find most useful for making your
decision? (Tick in column on right in table above).
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
75
B.10 Which of the following factors were important to you when
choosing your child’s booster seat? (Low/Medium/High)
For
Question
B.11
Low
Medium
High
Rank
Australian Standards approved
Comfort for child
Durability
Ease of access for child
Ease of access for parent/guardian
Ease of fitting into vehicle
Length of time that it would suit my child
Purchase price
Reputation of make/model of the restraint
Size/fit of the restraint in relation to my
vehicle
Style/look/colour of the restraint
Thickness of padding
Weight of the restraint
B.11 For those factors that you rated as “high” in B.10, please
rank only these in order from highest (1) to lowest priority.
Use the right hand column of the table in B.10 (1 = highest priority)
76
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
B.12 How did you know when to move your child from a toddler
child seat to a booster seat? (Tick as many as applicable).
Reasons
B.12
Tick which
reason/s apply
to you
B.13
Tick the most
important reason
(Tick one)
My child was too big for the toddler child seat
My child disliked sitting in the toddler child seat
I needed the toddler child seat for a younger child
My child would be more comfortable in a booster
seat compared to a seat belt
My child reached upper end of the weight range
recommended by the child seat manufacturer
My child would be safer in a booster seat
compared to a seat belt
My child thought that they were too grown up to sit
in a toddler child seat
My child’s shoulders were above the slots for the
harness straps
It would be easier to keep my child restrained in a
booster seat compared to a seat belt
A booster seat provides better visibility for my
child compared to a seat belt
My child had their 4th birthday
When my child started kindergarten
When my child started primary school
Other (please specify)
B.13 Which was the one most important reason in B.12 for
moving your child from a child restraint to a booster seat? (Tick in
column on right in table above)
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
77
B.14 How will you know when to move your child from a booster
seat to a seat belt? (Tick as many as applicable).
Reasons
B.14
Tick which
reason/s
apply to you
B.15
Tick the
most
important
reason
(Tick one)
When my child reaches the upper end of the
weight range recommended by the child seat
manufacturer
When my child’s eyes are level with the top of
the vehicle seat or headrest
When my child starts kindergarten
When my child starts primary school
Other (please specify)
B.15 Which will be the one most important reason in B.14 for
moving your child from a booster seat to a seat belt? (Tick in
column on right in table above)
Thank you for your participation
Please return the completed Sections A, B and C (if applicable)
to Monash University Accident Research Centre using the
provided reply-paid envelope.
78
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
Section C: Children’s use of seat belts
Please fill out this section only if one or more of your children aged 4 to
11 years is currently restrained by a seat belt while travelling in your
vehicle. If you have more than one child aged between 4 and 11 years
in your household, please answer the following section with regard to
the child who has most recently moved into a seat belt.
C.1
Please list the age, weight and height for your child who has
most recently moved into a seat belt.
Age:
_____ years _____ months
Gender:

Weight:
______ kilograms
Height:
______ centimetres
C.2
Male 
Female
What type of restraint did your child use immediately before
moving into a seat belt?

Child seat

Booster Seat

Other (please specify)
_________________________________________________________________
C.3
How old was your child when he/she made the transition to
a seat belt?
_________________________________________________________________
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
79
C.4
Please list the reasons why you moved your child into a seat
belt? (Tick as many as applicable).
Reasons
C.4
Tick which
reason/s
apply
to
you
C.5
Tick the most
important
reason
(Tick one)
My child was too big for the toddler child
seat/booster seat
My child disliked sitting in a toddler child
seat/booster seat
I needed the toddler child seat/booster seat for a
younger child
My child would be more comfortable in a seat belt
compared to a toddler child seat/booster seat
My child reached upper end of the weight range
recommended by the toddler child seat/booster
seat manufacturer
My child would be safer in a seat belt compared
to a toddler child seat/booster seat
My child thought that they were too grown up to
sit in a toddler child seat/booster seat
My child had their 4th birthday
My child started kindergarten
My child started primary school
Other (please specify)
C.5
Which was the one most important reason in C.4 for moving
your child from a toddler child seat/booster seat to a seat belt?
(Tick in column on right in table above)
Thank you for your participation
Please return the completed Sections A, C and B (if applicable)
to Monash University Accident Research Centre using the
provided reply-paid envelope.
80
MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE
Appendix 4: Expression of Interest for Future Research
Child Passenger Safety:
Children’s use of seat belts and booster seats
Expression of Interest for future research
Yes, I would like the Monash University Accident Research Centre to
contact me about participation in future research.
We are planning on investigating other aspects of child restraint safety in the
future. If you would like to take part in other research projects being conducted by
the Monash University Accident Research Centre, please complete the details
below and post it back to Monash University with your completed questionnaire in
the smaller reply paid envelope provided. A member of our research team will then
contact you at the convenient time via telephone and provide you with more
information about the research project. If you agree to be contacted, we would like
to emphasise that you are not obligated to participate in any future research.
Name: …………………………………………………………………………………
Contact phone number ……………………………………………………………
The best time to call me on the above number is: ……….…………am/pm
Thank you for your participation ☺
FACTORS THAT INFLUENCE CHILDREN’S BOOSTER SEAT USE
81
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